Preparation Artifacts
Julianne K. Purdy, MD
Key Facts
Clinical Issues
Colonic mucosal changes resolve within 2 weeks
Macroscopic Features
Small aphthoid lesions with pale center and erythematous halo
Mainly in distal colon and rectum
More common with sodium phosphate
Mucosa may appear normal
Microscopic Pathology
Focal active colitis, ↑ apoptosis in base of crypts, preserved crypt architecture
Intraepithelial PMNs over lymphoid follicles
Usually no surface ulceration
Top Differential Diagnoses
NSAID injury
Crohn disease
Graft-vs.-host disease
 Hematoxylin & eosin shows focal active colitis (neutrophils in crypt epithelium  ) with minimal extension into lamina propria  . |
 Hematoxylin & eosin shows apoptosis  at the base of colonic crypts. |
TERMINOLOGY
Definitions
Histologic changes in colonic mucosa resulting from endoscopic preparation regimens
ETIOLOGY/PATHOGENESIS
Environmental Exposure
Sodium phosphate, oral preparation, or enema
Metabolic effect rather than direct physical injury may cause basal colonic crypt changes
Phosphate salt may chelate free calcium ions (which suppress colonic epithelial turnover)
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