Yoga for bowel preparation before colonoscopy

Review by Prof. Vishal Sharma (India)

Study Summary 

A colonoscopy is required for the diagnosis of many intestinal diseases and colorectal cancer screening. An inadequate bowel preparation can lead to an increase in procedure time, missing lesions, complications, and re-appointments. Panigrahi et al. report their experience in using Shankhaprakshalana for bowel preparation. This technique utilizes five different yogic asanas with the intake of warm saline to prepare the bowel for colonoscopy. The authors report that the preparation was performed in the hospital on the day of the colonoscopy and a total of 2.4 liters of saline was ingested between the six cycles of five asanas done eight times in each cycle. Of 246 patients who agreed to this preparation, eight could not complete and eventually, 238 patients underwent colonoscopy. Adequate bowel preparation (a Boston Bowel Preparation Scale  ≥ 6) was seen in 99.2% while a perfect preparation was noted in 48.7%. Mild adverse events were reported in 10% of patients.

Yoga, based on the Sanskrit word ‘yuj’ meaning to unite, is an ancient Indian system of physical, mental, and spiritual exercises that probably originated in the Indus Saraswati civilization. The benefits of yoga have been reported in many diseases. The results of the present study suggest that Shankhaprakshalana could potentially provide a cheap, quick (mean time to complete preparation was 133) alternative for preparing patients for a same-day colonoscopy. The study was limited by retrospective design and a single-center setting. Also, there could be concerns about this preparation in patients with comorbidities like hypertension and renal failure and those who are physically unable to perform the asanas. Future studies should potentially compare this technique in randomized trials to standard preparation and also report on any abbreviated versions that may allow same-day colonoscopy in individuals with inadequate initial preparation.

Citation

Panigrahi MK, Prakash JH, Chouhan MI, Anirvan P, Chaudhary M, Gupta S, Nayak HK, R U AG, Manik R, Rath MM. Effectiveness and safety of Shankhaprakshalana-a yogic technique-in bowel preparation for colonoscopy: A retrospective study. Indian J Gastroenterol. 2023 Dec 19. doi: 10.1007/s12664-023-01488-9. Epub ahead of print. PMID: 38112914.

Link

https://link.springer.com/article/10.1007/s12664-023-01488-9

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