Aliaga Ramos J, Carvalho D, Nunes Arantes V. Innovative schemes of colonoscopy bowel preparation with oral lactulose: Optimizing traditional standards to improve colonoscopy quality. World J Gastrointest Endosc 2025; 17(7): 107168 [DOI: 10.4253/wjge.v17.i7.107168]
Corresponding Author of This Article
Josué Aliaga Ramos, MD, Department of Gastroenterology, Hospital José Agurto Tello-Chosica, 229 Walter Stubbs Street, Lima-Peru, Lima 15, Peru. arjosue3000@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Josué Aliaga Ramos, Department of Gastroenterology, Hospital José Agurto Tello-Chosica, Lima 15, Peru
Josué Aliaga Ramos, Service of Gastroenterology, Clinica Madre Zoraida, Lima 15, Peru
Josué Aliaga Ramos, Digestive Endoscopy, Unit Hospital San Juan de Matucana, Lima 15, Peru
Danilo Carvalho, Endoscopy, Federal University of Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Vitor Nunes Arantes, Endoscopy Unit, Alfa Institute of Gastroenterology, School of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Vitor Nunes Arantes, Endoscopy Unit, Mater Dei Contorno Hospital, Belo Horizonte 30110062, Minas Gerais, Brazil
Author contributions: Aliaga Ramos J, Arantes VN and Carvalho D performed the designed the research study; Aliaga Ramos J, Arantes VN and Carvalho D performed the research; Aliaga Ramos J, Arantes VN and Carvalho D performed the project administration; Aliaga Ramos J, Arantes VN and Carvalho D performed the writing–original draft; Aliaga Ramos J, Arantes VN and Carvalho D performed the writing–review & editing.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Josué Aliaga Ramos, MD, Department of Gastroenterology, Hospital José Agurto Tello-Chosica, 229 Walter Stubbs Street, Lima-Peru, Lima 15, Peru. arjosue3000@gmail.com
Received: March 17, 2025 Revised: April 26, 2025 Accepted: May 29, 2025 Published online: July 16, 2025 Processing time: 114 Days and 10.3 Hours
Abstract
The bowel preparation is a crucial step to achieve an optimal quality in colonoscopy. The major clinical impact of an adequate colonic cleansing is to allow a more detailed and thorough inspection reducing the rates of missing lesions during the procedure and consequently reducing the incidence of interval colorectal carcinomas. Currently there are different colonoscopic preparation schemes, being the polyethylene glycol (PEG) based regimen one of the most used and recommended by the main international clinical guidelines. Nevertheless, PEG preparation requires the ingestion of considerably large volumes to achieve an optimal colonic cleansing, leading to poor tolerability in may patients, particularly in an elderly population. Other aspects that make accessibility to most colonoscopy preparation regimens difficult is their high cost and low availability. New options of colonoscopic preparation schemes based on oral lactulose are emerging with promising results, showing excellent efficacy-safety profiles and high tolerability indexes. Lactulose regimens present other benefits such as low cost and wide availability. The aim of this review is to analyze the scientific evidence to date and the current status of colonoscopy bowel preparation utilizing lactulose-based regimens, in order to consolidate this agent as a feasible “new player” in the field of colonoscopic preparation.
Core Tip: Bowel preparation is critical for high-quality colonoscopy. Polyethylene glycol is considered the gold standard for bowel preparation, however the need for high volumes impairs patient’s tolerance. The oral lactulose-based scheme has emerged as a new alternative for colonoscopy preparation with a low cost, widely accessible to the general population and with optimal efficacy, safety and tolerability profiles.
