Expression of Concern on “Colonic gas explosion during therapeutic colonoscopy with electrocautery”

Abstract

This Expression of Concern is issued in regards to the article by Ladas et al, titled “Colonic gas explosion during therapeutic colonoscopy with electrocautery”, published in the World Journal of Gastroenterology (WJG) in 2007 (https://dx.doi.org/10.3748/wjg.v13.i40.5295). Concerns have been raised about whether the article’s recommendation to avoid bowel preparation agents containing poorly absorbed carbohydrates, such as mannitol or sorbitol, was adequately supported by the cited evidence. Following an editorial review of the concerns and the relevant references, the WJG Editorial Office found that some of the cited cases do not appear to involve mannitol- or sorbitol-containing preparations in the manner stated or implied in the article. Because these issues may affect readers’ interpretation of the article’s conclusions regarding bowel preparation and colonic gas explosion risk, this Expression of Concern is published as an alert to readers.

Key Words: World Journal of Gastroenterology; Expression of Concern

Core Tip: A reader raised concerns that the conclusion of the article “Colonic gas explosion during therapeutic colonoscopy with electrocautery”, published in the World Journal of Gastroenterology in 2007, may not have been supported adequately by the cited evidence, and may affect readers’ interpretation of bowel preparation risks. After reviewing the relevant references, the Editorial Office found that some cited cases do not appear to support this conclusion as presented. Therefore, this Expression of Concern is issued to alert readers and to recommend cautious interpretation of the relevant conclusions.

EXPRESSION OF CONCERN

Expression of Concern to: Ladas SD, Karamanolis G, Ben-Soussan E. Colonic gas explosion during therapeutic colonoscopy with electrocautery. World J Gastroenterol 2007; 13(40): 5295-5298 [PMID: 17879396 DOI: 10.3748/wjg.v13.i40.5295]. The online version of the original article can be found at https://www.wjgnet.com/1007-9327/full/v13/i40/5295.htm.

The World Journal of Gastroenterology (WJG) Editorial Office wishes to alert readers that concerns have been raised regarding the evidence supporting the article’s recommendations on bowel preparation for colonoscopy[1].

The WJG Editorial Office recently received a communication from a reader questioning the conclusion that “preparation agents containing poorly absorbed carbohydrates like mannitol or sorbitol can increase flammable gas levels and should be avoided” and that “polypectomy with electrocautery should only be performed after full bowel preparation with polyethylene glycol (PEG) or sodium phosphate (NaP) to prevent colonic explosion”.

According to the reader, a review of the references cited in the article identified several discrepancies between the bowel preparation agents reported in the original references and the way these cases were summarized in the article. In particular, the reader noted that, among the cases cited as involving mannitol preparation, only a limited number appeared to have actually used mannitol. Other cited cases reportedly involved PEG, magnesium carbonate, senna-based preparation, enemas, or no bowel preparation. The reader also noted that one preparation described as sorbitol-containing was in fact a combination of PEG and sorbitol.

In response to these concerns, the WJG Editorial Office reviewed the relevant references identified by the reader. Our review found that the cited evidence does not appear to sufficiently support the broad conclusion that bowel preparation agents containing poorly absorbed carbohydrates, such as mannitol or sorbitol, should be avoided on the basis that they may increase the risk of colonic gas explosion. In particular, among the 4 explosion cases discussed in relation to oral bowel preparation, only 1 case appeared to involve mannitol preparation, while other cases involved different preparation methods or agents.

Therefore, the WJG Editorial Office considers that the article’s conclusion regarding mannitol- and sorbitol-containing bowel preparations may be overly broad and not fully supported by the cited evidence. This issue may affect readers’ interpretation of the relative risks associated with different bowel preparation agents in the context of therapeutic colonoscopy with electrocautery.

Because the article was published approximately 18 years ago, the WJG Editorial Office attempted to contact the authors by email to request their response to these concerns. However, no response was received.

After careful consideration and in accordance with the publication ethics policies of the WJG, the WJG Editorial Office has decided to publish this Expression of Concern to alert readers to the above issue. This notice is intended to inform readers that the conclusions of the original article regarding bowel preparation agents should be interpreted with caution. This Expression of Concern does not constitute a retraction of the original article, but is intended to alert readers to a specific concern regarding the interpretation of the cited evidence.

The WJG Editorial Office appreciates the reader for bringing these concerns to our attention.