Impact of high‐volume, intermediate‐volume and low‐volume bowel preparation on colonoscopy quality and patient satisfaction: An observational study

Abstract Background and study aims Colonoscopy for colorectal cancer (CRC) screening has reduced CRC incidence and mortality and improved prognosis. Optimal bowel preparation and high-quality endoscopic technique facilitate early CRC detection.This review provides a narrative on the clinical importance of bowel preparation for colonoscopy and highlights available bowel preparations. Methods A PubMed search was conducted through June 2019 to identify studies evaluating clinical outcomes, efficacy, safety, and tolerability associated with bowel preparation for CRC screening-related colonoscopy. Results Selecting the optimal bowel preparation regimen is based on considerations of efficacy, safety, and tolerability, in conjunction with individual patient characteristics and preferences. Available bowel preparations include high-volume (4 L) and low-volume (2 L and 1 L), polyethylene glycol (PEG) solutions, sodium sulfate, sodium picosulfate/magnesium oxide plus anhydrous citric acid, sodium phosphate tablets, and the over-the-counter preparations magnesium citrate and PEG-3350. These preparations may be administered as a single dose on the same day or evening before, or as two doses administered the same day or evening before/morning of colonoscopy. Ingesting at least half the bowel preparation on the day of colonoscopy (split-dosing) is associated with higher adequate bowel preparation quality versus evening-before dosing (odds ratio [OR], 2.5; 95 % confidence interval [CI], 1.9−3.4). Conclusions High-quality bowel preparation is integral for optimal CRC screening/surveillance by colonoscopy. Over the last 30 years, patients and providers have gained more options for bowel preparation, including low-volume agents with enhanced tolerability and cleansing quality that are equivalent to 4 L preparations. Split-dosing is preferred for achieving a high-quality preparation.

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Low-volume PEG plus ascorbic acid versus high-volume PEG as bowel preparation for colonoscopy

Scandinavian Journal of Gastroenterology ◽

10.3109/00365521003734158 ◽

2010 ◽

Vol 45 (11) ◽

pp. 1380-1386 ◽

Cited By ~ 83

Author(s):

Sietske Corporaal ◽

Jan H. Kleibeuker ◽

Jan J. Koornstra

Keyword(s):

Ascorbic Acid ◽

Bowel Preparation ◽

High Volume ◽

Acid Versus ◽

Low Volume

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A pilot study for using high-volume colon irrigation bowel preparation for colon capsule endoscopy shows feasibility of adequate bowel prep with high patient satisfaction

Open Journal of Gastroenterology and Hepatology ◽

10.28933/ojgh-2021-03-1005 ◽

2021 ◽

pp. 49

Author(s):

◽

Keyword(s):

Patient Satisfaction ◽

Bowel Preparation ◽

High Volume ◽

High Patient Satisfaction ◽

Colon Capsule Endoscopy ◽

Colon Capsule ◽

Bowel Prep ◽

Colon Irrigation ◽

Patients Experience ◽

Oral Prep

A feasibility study was performed to test a bowel preparation (BP) method that would improve patients’ experience of colon capsule endoscope (CCE) while retaining clinical adequacy. Specifically, the use of high-volume colon irrigation with the Hygieacare® System, HygiPrep™, was tested in conjunction with Medtronic’s PillCam COLON 2 Capsule. This prospective, single-center, and IRB-approved study evaluated HygiPrep use prior to the PillCam COLON 2 procedure instead of the standard split-polyethylene glycol-electrolyte (PEG) oral prep. The study was performed at Austin Gastroenterology (Austin, TX), and all capsule video files were forwarded to a Central Reader to evaluate and compile a study report. Six of the seven (86%) subjects completed both the HygiPrep and PillCam COLON 2 exams and were graded as excellent, good, or adequate by the Central Reader. Patients’ feedback reported positive satisfaction scores for both the HygiPrep and the PillCam COLON 2 procedures. These results support our hypothesis that HygiPrep was as effective as Split-PEG BP. We suggest that the HygiPrep, is a suitable BP for CCE, providing adequate BP and high patient satisfaction.

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Effect of Bowel Preparation Volume in Inpatient Colonoscopy: Results of a Prospective, Randomized, Comparative Pilot Study

10.21203/rs.2.15794/v1 ◽

2019 ◽

Author(s):

Patricia V Hernandez ◽

Jennifer L. Horsley-Silva ◽

Diana L. Snyder ◽

Noemi Baffy ◽

Mary Atia ◽

...

Keyword(s):

Pilot Study ◽

Bowel Preparation ◽

Medical Center ◽

Controlled Trial ◽

High Volume ◽

Hospitalized Patients ◽

Inpatient Setting ◽

Volume Group ◽

Low Volume ◽

Colon Preparation

Abstract Background: Inpatient status has been shown to be a predictor of poor bowel preparation for colonoscopy; however, the optimal colon cleansing regimen protocol for hospitalized patients is unknown. Our aim was to compare the efficacy of bowel preparation volume size in hospitalized patients undergoing inpatient colonoscopy.Methods: This prospective, single blinded (endoscopist), randomized controlled trial was conducted as a pilot study at a tertiary referral medical center. Hospitalized patients undergoing inpatient colonoscopy were assigned randomly to receive a high, medium, or low-volume solution. Data collection included colon preparation quality based on the Boston Bowel Preparation Scale and a questionnaire given to all subjects, in which we evaluated the ability to completely finish bowel preparation and adverse effects (unpleasant taste, nausea, and vomiting). Results: Twenty-five colonoscopies were performed in 25 subjects. Patients who received low-volume prep averaged a higher mean total BBPS (7.4, SD 1.62), in comparison to patients who received high-volume (6.6, SD 2.19) and medium-volume prep (6.9, SD 1.55), P = 0.64. The low-volume group scored unpleasant taste as 0.6 (0.74), while the high-volume group gave unpleasant taste a score of 2.2 (0.97) and the medium-volume group gave a score of 2.1 (1.36), P < 0.01.Conclusion: Although not statistically significant, a low-volume colon preparation showed a trend of equivalent quality of bowel preparation measured by BBPS in comparison to traditional volume regimens, with less unpleasant taste, which may contribute to better patient compliance and therefore better bowel preparation in the inpatient setting. Further more robust studies are required to confirm these findings.Trial registration: clinicaltrials.gov NCT01978509

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New Ultra Low Volume Bowel Preparation and Overview of Existing Bowel Preparations

Current Drug Metabolism ◽

10.2174/1567201817666200810112136 ◽

2020 ◽

Vol 21 (11) ◽

pp. 844-849 ◽

Cited By ~ 1

Author(s):

Hein Htet ◽

Jonathan Segal

Keyword(s):

Clinical Trials ◽

Side Effects ◽

Bowel Preparation ◽

High Volume ◽

Extensive Literature ◽

Electrolyte Disturbances ◽

Bowel Cleansing ◽

Bowel Prep ◽

Low Volume ◽

Bowel Preparations

Background: Adequate bowel cleansing is essential in achieving a good quality colonoscopy. However, one of the barriers to achieving high-quality bowel cleansing is the patient's tolerability. Different bowel preparations have been developed to improve tolerability while maintaining adequate bowel cleansing. Objectives: We aim to explore the pros and cons of commonly used bowel preparations, particularly highlighting the new ultra-low volume bowel preparation. Methods:: Extensive literature search was carried out on various databases to evaluate the effectiveness and side effects of different bowel cleansing agents, including findings of recent clinical trials on ultra-low bowel preparation. Results:: Polyethylene glycol (PEG) has been commonly used as a bowel prep. Due to its high volume required to ingest to achieve an adequate effect, it has been combined with various adjuncts to reduce the volume to make it more tolerable. Magnesium and phosphate-based preps can achieve low volume, but they can be associated with multiple side effects, mainly electrolyte disturbances. Ultra low volume prep (NER1006) was achieved by combing PEG with ascorbic acid, and its efficacy and side effects were demonstrated in three noninferiority studies. Conclusion: It is important to consider patient preferences, co-morbidities and tolerability, and efficacy and side effect profiles when choosing bowel prep for patients undergoing colonoscopy. New ultra-low bowel prep showed promising results in initial clinical trials, but further real-world post-marketing data will inform its value in clinical practice.

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Tu1099 Impact of Bowel Preparation With Low-Volume (2-L) and Intermediate-Volume (3-L) Polyethylene Glycol on Colonoscopic Quality: A Prospective Observational Study

Gastroenterology ◽

10.1016/s0016-5085(15)32688-3 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-787

Author(s):

Chi-Liang Cheng ◽

Nai-Jen Liu ◽

Yi-Ning Tsui ◽

Cheng-Hui Lin ◽

Ming-Yao Su ◽

...

Keyword(s):

Polyethylene Glycol ◽

Observational Study ◽

Bowel Preparation ◽

Prospective Observational Study ◽

Low Volume

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Comparing the Real-World Effectiveness of High- Versus Low-Volume Split Colonoscopy Preparations: An Experience Through the British Columbia Colon Cancer Screening Program

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwaa031 ◽

2020 ◽

Author(s):

Joseph G H Lee ◽

Jennifer J Telford ◽

Cherry Galorport ◽

Jordan Yonge ◽

Christopher A Macdonnell ◽

...

Keyword(s):

Colon Cancer ◽

Bowel Preparation ◽

Detection Rate ◽

Screening Program ◽

High Volume ◽

Colon Cancer Screening ◽

Detection Rates ◽

Cancer Screening Program ◽

Adenoma Detection ◽

Low Volume

Abstract Background The British Columbia Colon Screening Program (BCCSP) is a population-based colon cancer screening program. In December 2018, physicians in Vancouver, Canada agreed to switch from a low-volume split preparation to a high-volume polyethylene glycol preparation after a meta-analysis of studies suggested superiority of the higher volume preparation in achieving adequate bowel cleansing and improving adenoma detection rates. Aims To compare the quality of bowel preparation and neoplasia detection rates using a high-volume split preparation (HVSP) versus a low-volume split preparation (LVSP) in patients undergoing colonoscopy in the BCCSP. Methods A retrospective review of patients undergoing colonoscopy through the BCCSP at St. Paul’s Hospital from July 2017 to November 2018 and December 2018 to November 2019 was conducted. Inclusion criteria included age 50 to 74 and patients undergoing colonoscopy through the BCCSP. Variables collected included patient demographics and bowel preparation quality. Rates of bowel preparation and neoplasia detection were analyzed using chi-squared test. Results A total of 1453 colonoscopies were included, 877 in the LVSP group and 576 in the HVSP group. No statistically significant difference was noted between rates of inadequate bowel preparation (LVSP 3.6% versus HVSP 2.8%; P = 0.364). Greater rates of excellent (48.4% versus 40.1%; P = 0.002) and optimal (90.1% versus 86.5%; P = 0.041) bowel preparation were achieved with HVSP. The overall adenoma detection rate was similar between the two groups (LVSP 53.1% versus HVSP 54.0%; P = 0.074). LVSP demonstrated higher overall sessile serrated lesion detection rate (9.5% versus 5.6%; P = 0.007). Conclusions Compared to LVSP, HVSP was associated with an increase in excellent and optimal bowel preparations, but without an improvement in overall neoplasia detection.

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