Comparison of Patterns of Laxative Ingestion to Improve Bowel Preparation for Colonoscopy: A Pilot Randomized Trial (NCT02062112)

Abstract

Introduction: Improving the experience of patients with bowel preparation process will enhance uptake and quality of screening colonoscopy. We hypothesize that patients will have better experience and outcomes if they taste PEG with and without flavoring before consuming the laxative. Methods: We conducted a single blind (endoscopist), parallel design, randomized trial (NCT 02062112) during which patients scheduled for colonoscopy were assigned to one of three groups. Group 1 patients (n = 84) were issued a gallon of PEG and were instructed to drink it without flavoring (unflavored group), group 2 patients (n = 90) were issued PEG with flavor packs and were instructed to flavor the entire gallon and drink, while group 3 patients (n = 82) were issued flavor packs but were instructed to taste a cup of PEG without flavoring and another cup with flavor and decide for themselves how they want to drink the rest (choice group). Split dose bowel preparation was recommended for all patients. On the day of their colonoscopy, patients used a scale of 1 to 10 (1 = unbearable; 5 = neutral and 10 = pleasant) to rank the taste of the laxatives, the ease of drinking, and overall experience of bowel preparation process. They were also asked if they would want the same laxative again if they were to undergo colonoscopy in the future. Adequacy of bowel preparation and presence of neoplasia were assessed by the patient's endoscopist who was blind to the randomization assignment of the patients. Results: There were no differences in the mean scores of patients across the groups (1, 2 and 3) in the taste of the laxatives (6.81 vs 7.69 vs 7.34, P = 0.67), the ease of drinking (7.47 vs 8.18 vs 7.84, P = 0.47), and overall experience of bowel preparation process (7.91 vs 8.09 vs 7.95, P = 0.25). Surprisingly, adequacy of bowel preparation of good to excellent was higher among patients who drank their PEG unflavored and subsequently had higher detection of adenoma even though they were less likely to want the same laxative again (Table). Patients in the choice group had 3-folds increased odds of willing to have the same laxative again. Conclusion: There were no differences in the overall tolerability of bowel preparation by patterns of flavoring of PEG. Those who had a choice pattern of laxative ingestion were more willing to have the same laxative again but those who drank unflavored PEG were less satisfied but had better clinical outcomes.Table 1: Comparison of satisfaction with bowel laxative, adequacy of bowel preparation and adenoma detection by patterns of flavoring of PEG