scholarly journals 3 Liter Polyethylene Glycol is Not Inferior to The Standard Bowel Preparation in Chinese Population with Equal Efficacy: A Randomized, Controlled Trial

2021 ◽  
Author(s):  
Peng Cheng ◽  
Qing-qi Chen ◽  
Ju-yuan Li ◽  
Zheng Cheng ◽  
Dian-hua Guo ◽  
...  
Keyword(s):  
Polyethylene Glycol ◽  
Adverse Events ◽  
Bowel Preparation ◽  
Chinese Population ◽  
Controlled Trial ◽  
Chinese Patients ◽  
Procedure Time ◽  
Adenoma Detection ◽  
Bowel Cleansing

Abstract Background Ideal bowel cleansing regimens should be both effective and well tolerated. The European Society of Gastrointestinal Endoscopy recommends 4L Polyethylene Glycol (PEG) as the standard regimen for the bowel preparation (BP). This large volume of PEG ensures a better-quality bowel cleansing but might be poorly tolerated amongst the Chinese population given their different characteristics. The current study compared the 3L and 4L PEG with regard to their effectiveness, tolerability, and safety amongst Chinese patients to identify the better suitable bowel cleansing method for this population. Methods This study employed a prospective, observer-blinded, randomized and controlled design in a high-volume endoscopic center. Consecutive patients undergoing colonoscopy were randomly assigned (1:1) to the 3L-PEG or 4L-PEG group. The quality of bowel cleansing, procedure time, adenoma detection rate (ADR), patient tolerance, and adverse events were compared. Results A total of 330 patients were included in the study. The quality of the bowel cleansing (Boston Bowel Preparation Scale) for both the whole intestine and each segment showing no significant differences between the groups. No significant differences were present with regard to the procedure time or ADR. The incidences of adverse events such as nausea (P = 0.001) and bloating (P < 0.001)were significantly lower in the 3L-PEG group. Moreover, there was a significantly higher rate of satisfaction in 3L-PEG group than that of the 4L-PEG group (P = 0.009). Conclusions 3L-PEG bowel cleansing represents an optimal alternative to a 4L-PEG preparation for Chinese people, showing a similar efficacy and superior levels of satisfaction, acceptability, and safety amongst users. We recommend 3L PEG be the routine regimen in the clinical setting for Chinese patients. (ClinicalTrials.gov registration number: NCT03356015, registered in 29 November, 2017, https://www.clinicaltrials.gov/ct2/show/NCT03356015)

Impact of preprocedure simethicone on adenoma detection rate during colonoscopy: a multicenter, endoscopist-blinded randomized controlled trial

Endoscopy ◽  
2017 ◽  
Author(s):  
Yu Bai ◽  
Jun Fang ◽  
Sheng-Bing Zhao ◽  
Dong Wang ◽  
Yan-Qing Li ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Bowel Preparation ◽  
Detection Rate ◽  
Controlled Trial ◽  
Complete Removal ◽  
Adenoma Detection Rate ◽  
Randomized Controlled ◽  
Adenoma Detection ◽  
Bowel Cleansing ◽  
Registration Number

Abstract Background and study aims Ideal bowel preparation for colonoscopy requires complete removal of fluid and foam from the colon. Polyethylene glycol (PEG) is widely used for bowel preparation, with antifoaming agents such as simethicone commonly used in combination with PEG. Data on the effect of simethicone on the adenoma detection rate (ADR) were limited. This study therefore aimed to investigate whether preprocedure simethicone could increase the ADR. Patients and methods This was a prospective, multicenter, endoscopist-blinded randomized controlled trial involving consecutive patients who underwent colonoscopy in six centers in China. Patients were randomly assigned to one of two groups: PEG plus simethicone or PEG alone. The primary outcome was ADR; secondary outcomes were quality of bowel preparation, measured by the Boston bowel preparation scale (BBPS) and bubble scores. Results 583 patients were included. More adenomas were detected in the PEG plus simethicone group than in the PEG alone group (ADR 21.0 % vs. 14.3 %, P = 0.04; advanced ADR 9.0 % vs. 7.0 %, P = 0.38). The mean number of adenomas detected was 2.20 ± 1.36 vs. 1.63 ± 0.89 (P = 0.02). Patients in the PEG plus simethicone group showed better bowel cleansing efficacy: BBPS ≥ 6 in 88.3 % vs. 75.2 % (P < 0.001) and bubble scores of 1.00 ± 1.26 vs. 3.98 ± 2.50 (P < 0.001). Abdominal bloating was reported less frequently in the PEG plus simethicone group (7.8 % vs. 19.7 %, P < 0.001) than in the PEG alone group. Conclusion Combined use of PEG and simethicone is associated with a significantly increased ADR in a Chinese population.Clinical trials registration number: NCT02540239

scholarly journals Efficacy and Patient Tolerability Profiles of Probiotic Solution with Bisacodyl Versus Conventional Cleansing Solution for Bowel Preparation: A Prospective, Randomized, Controlled Trial

2020 ◽  
Vol 9 (10) ◽  
pp. 3286
Author(s):  
Youn I Choi ◽  
Jong-Joon Lee ◽  
Jun-Won Chung ◽  
Kyoung Oh Kim ◽  
Yoon Jae Kim ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Detection Rate ◽  
Controlled Trial ◽  
Screening Colonoscopy ◽  
Control Group ◽  
Case Group ◽  
Detection Rates ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Bowel Cleansing

Although adequate bowel preparation is essential in screening colonoscopy, patient intolerability to bowel cleansing agents is problematic. Recently, a probiotic mixture solution with bisacodyl emerged to improve patient tolerability. We investigated the efficacy, safety, and patient tolerability profiles of probiotics with bisacodyl versus conventional polyethylene glycol (PEG) solution for bowel preparation for screening colonoscopies in healthy patients in this prospective, randomized, case-control study. In total, 385 volunteers were randomly assigned to receive 2 L of water + 200 mL of probiotic solution (case group, n = 195) or 4 L of PEG solution (control group, n = 190). The efficacy of the bowel cleansing was evaluated using the Ottawa scale system, polyp detection rate, and adenoma detection rate, and the patient tolerability profiles were assessed using a questionnaire. The demographics were not significantly different between groups. When the Ottawa score for each bowel segment was stratified into an adequate vs. inadequate level (Ottawa score ≤ 3 vs. >3), there were no statistical differences between groups in each segment of the colon. There were no significant differences in the polyp and adenoma detection rates between groups (38.42% vs. 32.42, p = 0.30; 25.79% vs. 18.97%, p = 0.11). The case group showed significantly fewer events than the control group, especially nausea, vomiting, and abdominal bloating events. Regarding the overall satisfaction grade, the case group reported significantly more “average” scores (95% vs. 44%, p < 0.001) and were more willing to use the same agents again (90.26% vs. 61.85%, p < 0.001). As patient compliance with bowel preparation agents is associated with an adequate level of bowel cleansing, a probiotic solution with bisacodyl might be a new bowel preparation candidate, especially in patients who show a poor compliance with conventional bowel preparation agents.

scholarly journals The Effectiveness, Tolerability, and Safety of Different 1-Day Bowel Preparation Regimens for Pediatric Colonoscopy

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Anna Szaflarska-Popławska ◽  
Dominika Tunowska ◽  
Ola Sobieska-Poszwa ◽  
Anna Gorecka ◽  
Aneta Krogulska
Keyword(s):  
Polyethylene Glycol ◽  
Adverse Events ◽  
Bowel Preparation ◽  
Similar Efficacy ◽  
Serious Adverse Events ◽  
Preparation Methods ◽  
Sodium Picosulphate ◽  
Bowel Cleansing ◽  
Patient Reported ◽  
Colonoscopy Preparation

Background. Currently, there is no generally accepted universal protocol for bowel preparation before colonoscopy in children. Aim. The aim of the study was to compare three different 1-day bowel preparation methods for a pediatric elective colonoscopy in terms of their efficacy, safety, and patient-reported tolerability. Material and Methods. The study was randomized, prospective, and investigator-blinded. All children aged 10 to 18 years consecutively referred to the tertiary pediatric gastroenterology unit were enrolled. The participants were randomized to receive polyethylene glycol 3350 combined with bisacodyl (PEG-bisacodyl group), or polyethylene glycol 4000 with electrolytes (PEG-ELS group), or sodium picosulphate plus magnesium oxide plus citric acid (NaPico+MgCit group). Bowel preparation was assessed according to the Boston Bowel Preparation Scale (BBPS). For patient tolerability and acceptability, questionnaires were obtained. Results. One hundred twenty-three children were allocated to three age- and sex-matched groups. All of the patients completed colonoscopies with visualization of the cecum. There was no difference among the groups for the mean BBPS score. A total of 73 patients (59.3%) experienced minor adverse events. No serious adverse events occurred in any group. Nausea was the only symptom more frequent in the PEG-ELS group compared to the NaPico+MgCit group (p=0.04), and apathy was the only symptom more frequent in PEG-bisacodyl than in the NaPico+MgCit group (p=0.04). All of the patients were able to complete 75% or more of the study protocol, and 85.4% were able to complete the full regimen. The acceptability was the highest in the NaPico+MgCit group with respect to the patient’s grade for palatability, low volume of the solution, and willingness to repeat the same protocol. Conclusion. All bowel cleansing methods show similar efficacy. However, because of the higher tolerability and acceptability profile, the NaPico+MgCit-based regimen appears to be the most proper for colonoscopy preparation in children.

scholarly journals Comparison of Polyethylene Glycol versus Lactulose Oral Solution for Bowel Preparation prior to Colonoscopy

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Chun-Xia Li ◽  
Yan Guo ◽  
Yang-Jie Zhu ◽  
Jian-Ru Zhu ◽  
Qian-Song Xiao ◽  
...  
Keyword(s):  
Polyethylene Glycol ◽  
Bowel Preparation ◽  
Oral Solution ◽  
Physician Satisfaction ◽  
Detection Rates ◽  
Bowel Cleansing ◽  
Degree Of Satisfaction ◽  
Bowel Preparations ◽  
Colonoscopy Preparation

Objective. This study was conducted to compare a lactulose oral solution with a polyethylene glycol (PEG) formulation for colonoscopy preparation using the following metrics: quality of cleansing, colonoscopy outcomes, patient/physician satisfaction, and patient tolerability. Methods. The enrolled patients were randomly divided into two groups and received a single 2 L dose of either PEG (PEG group) or lactulose (Lac group). The Boston Bowel Preparation Scale (BBPS) was used for assessing the cleansing quality of the bowel preparations. Patient tolerability and adverse events were obtained through the completion of questionnaires. Results. The lactulose oral solution showed superior bowel cleansing compared to PEG, as evidenced by higher BBPS scores in the Lac group for all segments of the colon (P<0.05). The detection rates of polyps and intestinal lesions in the Lac group (30.68% and 36.36%, respectively) were significantly higher than those in the PEG group (12.50% vs. 13.63%, respectively). For the degree of satisfaction, the Lac group had significantly higher scores compared to the PEG group, as evaluated by both the patients and endoscopist. PEG was associated with an increased incidence of nausea. There were no statistical differences between the groups in terms of vomiting, abdominal pain or fullness, dizziness, unfavorable palatability, dry mouth, palpitation, tinnitus, and tongue numbness. Conclusion. A single 2 L dose of a lactulose oral solution had higher efficacy, improved tolerability, and acceptable safety for bowel preparation when compared to the same volume of PEG. Thus, a lactulose oral solution may be a potential bowel-cleansing option for colonoscopy preparation.

scholarly journals Bowel-cleansing efficacy of the 1L polyethylene glycol-based bowel preparation NER1006 (PLENVU) in patient subgroups in two phase III trials

2021 ◽  
Vol 14 ◽  
pp. 175628482110202
Author(s):  
Sandra Baile-Maxia ◽  
Bharat Amlani ◽  
Rodrigo Jover Martínez
Keyword(s):  
Colorectal Cancer ◽  
Polyethylene Glycol ◽  
High Risk ◽  
Bowel Preparation ◽  
Phase Iii ◽  
Plain Language ◽  
Split Dose ◽  
Adenoma Detection ◽  
Increased Risk ◽  
Bowel Cleansing

Background: Adequate bowel preparation prior to colonoscopy is essential for visualization of the colonic mucosa to maximize adenoma and polyp detection. The risk of inadequate bowel cleansing is heightened if the patient is older, male, overweight, and has comorbidities, such as diabetes. This post hoc analysis of the combined MORA and NOCT clinical trials explores the efficacy of evening/morning split-dose regimens of NER1006 (PLENVU®, Norgine Ltd), a 1-liter polyethylene glycol (PEG) bowel preparation, to evaluate its bowel-cleansing efficacy in patients at risk for inadequate cleansing. Methods: Patients requiring colonoscopy were randomized to receive evening/morning split-dosing of either NER1006, 2-liter (2L) PEG and ascorbate, or oral sulfate solution (OSS). Bowel-cleansing efficacy was assessed by treatment-blinded central readers using the validated Harefield Cleansing Scale (HCS). Results: Split-dose NER1006 was associated with high levels of cleansing, ranging between 87.0% and 94.0% across all patient subtypes ( n = 551), including patients with obesity or diabetes. However, patients aged >65 years and <45 years showed significantly greater rates of successful cleansing than patients aged 45–65 years (94.0% versus 94.2% versus 87.0%, p = 0.002). The high-risk patient subgroup, which included obese males aged ⩾60 years, had significantly improved overall and high-quality bowel-cleansing success rates of 100% (33/33) and 72.7% (27/33) on the HCS with NER1006, compared with 86.7% (26/30) and 50% (15/30) with the comparator solutions ( p = 0.015 and p = 0.033, respectively). In this high-risk subgroup, adenoma detection was greater per patient receiving NER1006 versus the comparator group (1.82 versus 0.93, p = 0.041). NER1006 was the only treatment that enabled the detection of patients with ⩾5 adenomas [9.1% (3/33) versus 0/30, p = 0.047]. Conclusion: NER1006 effectively cleansed a broad range of patients and offered superior bowel cleansing versus 2LPEG/OSS in patients at increased risk of colorectal cancer. Future research should establish whether more effective cleansing also enables improved adenoma detection. Plain language summary A low-volume bowel preparation solution to better detect lesions associated with colorectal cancer during colonoscopy Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer in the world. Obese men over the age of 65 years are at particularly increased risk of developing CRC. If the changes in their large intestine (colon) could be seen more clearly during a colonoscopy (where a small camera is inserted via the anus to examine the bowels from the inside), patients who need treatment would be diagnosed earlier, thus improving their chances of survival. In this paper we discuss the use of a bowel preparation solution that is more convenient for patients (less to drink) but also cleans bowels more effectively, meaning more lesions are detected than when other solutions are used. This improved cleansing, and thus better visualization, occurred in a range of patients, including those at higher risk of CRC, such as older, overweight men.

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

2017 ◽  
Vol 55 (1) ◽  
pp. 36-43 ◽  
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.

Simethicone improves bowel cleansing with low-volume polyethylene glycol: a multicenter randomized trial

Endoscopy ◽  
2017 ◽  
Vol 50 (04) ◽  
pp. 412-422 ◽  
Author(s):  
Shenghong Zhang ◽  
Danping Zheng ◽  
Jinping Wang ◽  
Jianwei Wu ◽  
Pingguang Lei ◽  
...  
Keyword(s):  
Polyethylene Glycol ◽  
Bowel Preparation ◽  
Conventional Group ◽  
Intubation Time ◽  
Cecal Intubation ◽  
Adenoma Detection ◽  
Bowel Cleansing ◽  
Cecal Intubation Time ◽  
Low Volume ◽  
The Right

Abstract Background and study aims For bowel preparation, using a reduced volume of polyethylene glycol (PEG) solution without influencing its effectiveness would be preferable. While simethicone shows great potential as an adjunctive agent, data on its use are limited. We aimed to clarify whether simethicone added to low-volume PEG solution improved bowel cleansing. Patients and methods Consecutive adult patients registered for colonoscopy were recruited from seven medical centers in South China between 15 April and 15 July 2015 and prospectively randomized into two groups: 2 L PEG (conventional group) and 2 L PEG plus simethicone (simethicone group). The primary endpoint was the effectiveness of bowel cleansing according to the Boston Bowel Preparation Scale (BBPS). Secondary endpoints included cecal intubation time, adenoma detection rate (ADR), patient safety and compliance, and adverse events. Results We included 290 and 289 patients in the conventional and simethicone groups, respectively, for analysis. The proportion with acceptable bowel cleansing (BBPS ≥ 6) was significantly higher in the simethicone group than in the conventional group (88.2 % vs. 76.6 %; P < 0.001). The mean (SD) BBPS score was significantly lower in the conventional group (6.5 [1.8] vs. 7.3 [1.7]; P < 0.001), as was the bubble score (2.5 [0.7] vs. 2.8 [0.5]; P < 0.001). The average cecal intubation time was significantly shorter in the simethicone group (6.3 [3.1] vs. 7.5 [5.1] minutes; P < 0.001). The ADR in the right colon was higher in the simethicone group than in the conventional group (16.6 % vs. 10.3 %; P = 0.03). Safety and compliance, including the taste, smell, and dosage of PEG, were similar for both groups. Conclusions Simethicone added to low-volume PEG solution improves bowel-cleansing efficacy, with similar safety and compliance, shorter cecal intubation time, and higher ADR.

scholarly journals Effect of physician-provided education on the quality of bowel preparation

2021 ◽  
Vol 84 (3) ◽  
Author(s):  
B Dikkanoğlu ◽  
A.E. Duman ◽  
S Hülagü
Keyword(s):  
Bowel Preparation ◽  
Control Group ◽  
Procedure Time ◽  
Cecal Intubation ◽  
Detection Rates ◽  
Written Information ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Inadequate Bowel Preparation

Background and study aims : Inadequate bowel preparation inpatients scheduled for colonoscopy is an important problem. Inour study, we aimed to investigate the effect of physician-providedbowel preparation education on the quality of bowel preparationand process. Patients and methods : A total of 150 outpatients who were referredto Kocaeli University Medical Faculty Hospital GastroenterologyUnit for colonoscopy between May 2019 and October 2019 wereenrolled in our prospective, endoscopist-blinded study. Patientswere divided into two groups. Group 1 (education group) included73 patients who received 10 minutes of verbal information froma physician in addition to a written information form. Group 2(control group) included 75 patients who received informationfrom a medical secretary in addition to a written information form.During colonoscopy, the quality of bowel preparation was assessedusing the Boston bowel preparation scale (BBPS). A BBPS score≥ 5 was considered adequate bowel preparation. The mean BBPSscore, polyp detection rate, cecal intubation rate and time, andprocedure time were also evaluated. Results : The rate of adequate bowel preparation (BBPS score≥ 5) was 90.4% and 74.7% in groups 1 and 2, respectively (p =0.021). The odds ratio for having a BBPS score ≥ 5 in the educationgroup was 3.199 compared with the control group (95% confidenceinterval = 1.254-8.164; p = 0.015). The cecal intubation rates were91.8% and 88% in groups 1 and 2, respectively (p > 0.05). The cecalintubation time, procedure time, and adenoma detection rates weresimilar between the groups. The relationships of age, educationlevel, sex, diabetes mellitus, medicine use, procedure time, andintraabdominal surgery with inadequate bowel preparationwere analysed using a logistic regression model. Univariate andmultivariate analyses revealed no significant factors associatedwith inadequate bowel preparation. Conclusions : Patient education on the bowel preparationprocess via a physician improved the quality of bowel preparation.

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