1. R4 박 철 기 Endoscopy 2010; 42: 109–113

2. Introduction  Sodium phosphate (NaP – Fleet) Osmotic laxative – increase colonic water content by extracellular fluid efflux through the bowel wall and by maintaining fluids in the lumen adverse effect : dehydration (ARF), electrolyte imbalance, such as hypernatremia, hypokalemia, hypocalcemia, hyperphosphatemia

3. Introduction  Purpose of this study  assessed the risk factors for hemorrhagic gastropathy to evaluate whether bowel preparation using NaP increased the incidence of hemorrhagic gastropathy in healthy individuals

4. Patients and Methods  Patients : A cross-sectional observational study National cancer center, Korea, from May 2001 to May 2007 Inclusion criteria -- Individuals undergoing health check-ups with EGD for gastric cancer screening Exclusion criteria -- Hx of previous gastric or colon surgery Personal data (age, sex, alcohol consumption, smoking status, personal medical and medication history) was collected prior to endoscopic procedure

5. Patients and Methods Endoscopy (Olympus) 45ml of NaP with 240ml of water at 7 pm before the procedure day  10mg of bisacodyl tablet with 1500ml of water  45ml of NaP with 240ml of water at 10 pm followed by 1500ml of water Endoscopic finding Grade o : normal mucosa Grade 1 : mucosal hemorrhages only Grade 2 : one or two erosions Grade 3 : Numerous erosions (3~10) Grade 4 : many(>10) erosions or an ulcer  Mild ( Grade 1 or 2 ) : moderate ( Grade 3 ) : severe ( Grade 4 )

6. Patients and Methods  Method Blood and urine sample obtained 2 hours before the endoscopy Weight and height (In-Body)  BMI calculation Antral biopsy specimen for H-pylori assessment using rapid urease test  Statistical analysis The pearson chi-squared test and independent t-test : difference the use and the non-use of oral NaP logistic regression : odd-ratios(OR) and 95% confidence intervals (Cis) STATA software(version 10) for all statistical analysis

7. Results NaP use group 에서 male predominence, current smoker & drinker 가 more common

8. Results More frequent electrolyte imbalance in NaP use group But no significant hemodynamic instability or adverse effects

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10. Results

11. Results

12. Conclusion  Oral NaP bowel preparation for colonoscopy was associated with hemorrhagic gastropathy.  Clinically, When dual endoscopy is employed to evaluate positive fecal occult blood test, the use of NaP might result in misinterpretation of the resultant hemorrhagic gastropathy as a source of bleeding. Alternatively, the NaP solution may even induce bleeding at pre-existing mucosal lesions

13. Addendum…