Does 2-L Split-Dose Polyethylene Glycol Bowel Preparation Improve the Quality of Screening Colonoscopy?

BACKGROUND: Adequate bowel preparation for colonoscopy is an important predictor of colonoscopy quality.OBJECTIVE: To determine the difference in terms of effectiveness between different existing colon cleansing products in the setting of a colorectal cancer screening program.METHODS: The records of consecutive patients who underwent colonoscopy at the Montreal General Hospital (Montreal, Quebec) between April 2013 and April 2014 were retrospectively extracted from a dedicated electronic digestive endoscopic institutional database.RESULTS: Overall, 2867 charts of patients undergoing colonoscopy were assessed, of which 1130 colonoscopies were performed in a screening setting; patients had adequate bowel preparation in 90%. Quality of preparation was documented in only 61%. Bowel preparation was worse in patients receiving sodium picosulfate (PICO) alone compared with polyethylene glycol, in a screening setting (OR 0.3 [95% CI 0.2 to 0.6]). Regardless of the preparation type, the odds of achieving adequate quality cleansing was 6.6 for patients receiving a split-dose regimen (OR 6.6 [95% CI 2.1 to 21.1]). In multivariable analyses, clinical variables associated with inadequate bowel preparation in combined population were use of PICO, a nonsplit regimen and inpatient status. The polyp detection rate was very high (45.6%) and was correlated with withdrawal time.CONCLUSION: Preparation quality needs to be more consistently included in the colonoscopy report. Split-dose regimens increased the quality of colon cleansing across all types of preparations and should be the preferred method of administration. Polyethylene glycol alone provided better bowel cleansing efficacy than PICO in a screening setting but PICO remains an alternative in association with an adjuvant.

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Preparation regimen is more important than patient-related factors: a randomized trial comparing a standard bowel preparation before colonoscopy with an individualized approach

Romanian Journal of Internal Medicine ◽

10.1515/rjim-2016-0047 ◽

2017 ◽

Vol 55 (1) ◽

pp. 36-43 ◽

Cited By ~ 1

Author(s):

T. Voiosu ◽

Alina Tanţău ◽

A. Voiosu ◽

Andreea Benguş ◽

Cristina Mocanu ◽

...

Keyword(s):

Polyethylene Glycol ◽

Bowel Preparation ◽

Multivariable Analysis ◽

Standard Group ◽

Related Factors ◽

Split Dose ◽

Bowel Cleansing ◽

Significant Difference ◽

Bowel Prep

Abstract Background. Optimal bowel preparation is one of the most important factors affecting the quality of colonoscopy. Several patient-related factors are known to influence the quality of bowel cleansing but randomized trials in this area are lacking. We aimed to compare an individualized bowel prep strategy based on patient characteristics to a standard preparation regimen. Material and Methods. We conducted an endoscopist-blinded multicenter randomized control-trial. The Boston Bowel Prep Score (BBPS) was used to assess quality of bowel preparation and a 10 point visual analogue scale to assess patient comfort during bowel prep. Patients were randomised to either the standard regimens of split-dose 4L polyethylene-glycol (group A), split-dose sodium picosulphate/magnesium citrate (group B) or to either of the two depending on their responses to a 3-item questionnaire (individualized preparation, group C). Results. 185 patients were randomized during the study period and 143 patients were included in the final analysis. Patients in the individualized group had a median BBPS of 7 compared to a median of 6 in the standard group (p = 0.7). Also, there was no significant difference in patients’ comfort scores, irrespective of study group or laxative regimen. However, on multivariable analysis, a split-dose 4L polyethylene-glycol was an independent predictor for achieving a BBPS>6 (OR 3.7, 95% CI 1.4-9.8), regardless of patient-related factors. Conclusion. The choice of laxative seems to be more important than patient-related factors in predicting bowel cleansing. Comfort during bowel prep is not influenced by the type of strategy used.

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P.03.9 COMPARISON BETWEEN AN ASYMMETRIC (SMALL DOSE IN THE MORNING) AND A SYMMETRIC SPLIT-DOSE REGIMEN OF POLYETHYLENE GLYCOL PLUS BISACODYL FOR BOWEL PREPARATION FOR SCREENING COLONOSCOPY: A RANDOMIZED NON-INFERIORITY CLINICAL TRIAL

Digestive and Liver Disease ◽

10.1016/s1590-8658(18)30449-3 ◽

2018 ◽

Vol 50 (2) ◽

pp. e146-e147

Author(s):

G. De Nucci ◽

P. Andreozzi ◽

D. Redaelli ◽

D. Morganti ◽

E.D. Mandelli ◽

...

Keyword(s):

Clinical Trial ◽

Polyethylene Glycol ◽

Bowel Preparation ◽

Small Dose ◽

Dose Regimen ◽

Screening Colonoscopy ◽

Split Dose

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P.12.5: Comparison Between an Asymmetric (Small Dose in the Morning) and a Symmetric Split-Dose Regimen of Polyethylene Glycol Plus Bisacodyl for Bowel Preparation for Screening Colonoscopy: A Randomized Non-Inferiority Clinical Trial

Digestive and Liver Disease ◽

10.1016/s1590-8658(17)30592-3 ◽

2017 ◽

Vol 49 ◽

pp. e213

Author(s):

G. De Nucci ◽

C. Bezzio ◽

P. Andreozzi ◽

I. Arena ◽

M. Devani ◽

...

Keyword(s):

Clinical Trial ◽

Polyethylene Glycol ◽

Bowel Preparation ◽

Small Dose ◽

Dose Regimen ◽

Screening Colonoscopy ◽

Split Dose

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Same day versus split dose bowel preparation for afternoon colonoscopy: impact on mucosal visibility and patient quality of life

Gut ◽

10.1136/gut.2011.239301.83 ◽

2011 ◽

Vol 60 (Suppl 1) ◽

pp. A42-A42 ◽

Cited By ~ 1

Author(s):

G. Longcroft-Wheaton ◽

P. Bhandari

Keyword(s):

Quality Of Life ◽

Bowel Preparation ◽

Split Dose

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Factors Affecting Proximal Colon Cleansing Based on Bowel Movement Kinetics: A Prospective Observational Study

Gastroenterology Research and Practice ◽

10.1155/2019/7032971 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Dae Bum Kim ◽

Kang-Moon Lee ◽

Sung-Goo Kang ◽

Sung Hoon Jung

Keyword(s):

Waist Circumference ◽

Bowel Preparation ◽

Female Gender ◽

Distal Colon ◽

Proximal Colon ◽

Screening Colonoscopy ◽

Factors Affecting ◽

Colon Cleansing ◽

Fair Poor

Background. Previous studies have suggested that relatively poor bowel preparation in the proximal colon, compared to that in the distal colon, could decrease the usefulness of colonoscopy. The aim of this study was to determine whether the “first defecation time” after polyethylene glycol (PEG) administration affects the cleansing quality in the proximal colon. Methods. A total of 425 individuals who were scheduled to undergo a screening colonoscopy were enrolled prospectively at the healthcare center of St. Vincent’s Hospital, Suwon, Korea, between April 2015 and March 2016. Bowel cleansing was performed using 4 L of PEG. Surveys were conducted to obtain information regarding the “first defecation time.” Endoscopists assessed the quality of bowel preparation in each bowel segment. Results. We investigated 425 consecutive eligible cases. The mean “first defecation time” after PEG administration was 54.35 min. The quality of bowel preparation was poorer in the proximal colon than that in the distal colon. The adequate (excellent, good) and inadequate (fair, poor) proximal colon preparation groups comprised 360 (84.7%) and 65 (15.3%) patients, respectively. A multivariate analysis revealed that female gender (P=0.029), small waist circumference (P=0.027), and the long “first defecation time” (P=0.034) were independently associated with inadequate bowel preparation in the proximal colon. Conclusion. Our data document that the “first defecation time,” female gender, and a small waist circumference affect the quality of preparation in the proximal colon. Inadequate preparation in the proximal colon was more common in females. Patients with these factors undergoing colonoscopy should be monitored carefully.

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