Analysis of Various Colonoscopy Preparation Methods and Its Advantages and Complications – An Observational, Cross-Sectional, Multicenter Study

Abstract

Aims and Objectives: Colorectal cancer (CRC) represents the fourth most deadly malignancy and the third most common cause of cancer worldwide. Currently, colonoscopy is a frequent procedure that, with specific indications, helps in the diagnosis and treatment of multiple diseases of the colon and continues to be the study of choice for the timely detection of CRC and premalignant lesions. The aim of this study was to assess the colonic cleanliness obtained with various regimens used in colonoscopy preparation. Methods: This is an observational, cross-sectional, multicenter analytical study. All patients undergoing colonoscopy on an outpatient basis annually in 3 centers associated with a university hospital in Netherlands were evaluated. The study included 352 subjects undergoing colonoscopy in the endoscopy unit between Jan and Dec of 2018. Results: This study found that inadequate level of preparation was seen in 13% of patients, a majority of which failed to complete the preparation regimen and had a longer period between the end of the preparation and the time of colonoscopy (12 vs. 6 h) with P <0.001. Cecal and ileocecal valve intubation rates were higher in patients with inadequate preparation. The majority of polyps were detected in colonoscopies with adequate cleaning (42%), while in patients with inadequate preparation the finding of polyps was lower (33%). Mannitol was the agent that obtained the highest percentage of adequate bowel preparation (P <0.001) and compliance (P 0.002), followed by split dose PEG. Similarly, cecal intubation rates as well as ileocecal valve intubation was higher with these agents (P <0.001), as well as the detection of polyps (P = 0.4). Most adverse effects were presented with PEG 3 L, with nausea being the most referred symptom. Conclusion: Mannitol was the preparation with which the highest percentage of studies was obtained with an adequate intestinal preparation, followed by the divided dose PEG. Failure to comply with the regimen and a greater number of hours elapsed between the end of the regime intake and the endoscopic study as independent predictors of inadequate cleaning were found. The PEG-based regimens and the low level of instruction were also associated with inadequate preparation, however, depending on the compliance and the number of hours elapsed.