Comparison of Quality of Bowel Preparation With Different Regimens of Polyethylene Glycol in Inner City Minority Population

Abstract

Introduction: A good bowel preparation that ensures adequate colonic mucosal visualization during colonoscopy is essential to detect colon polyps and other colon pathologies. Suboptimal bowel preparation leads to lower adenoma detection rate (ADR), a key quality indicator and crucial component for the prevention of colorectal cancer. Polyethylene glycol with electrolytes (Golytely) is the commonest formulation used for bowel preparation at our hospital center. A few studies have shown that split administration of Golytely is superior to previous day administration. However, studies comparing the three regimens of Golytely administration, the previous day, split, and same day regimens are scarce. Methods: This is a retrospective study of patients who underwent screening colonoscopies at our hospital between October 1, 2014, and July 31, 2016, were included. The patients were divided into three groups based on the regimen of PEG solution administered. Demographic data, social history, medical comorbidities, HbA1C, colonoscopy findings and polyp pathology were collected and Adenoma detection rate (ADR) was calculated. Data between the three groups were compared and analyzed using SAS software and a two-sided p-value < 0.05 was considered statistically significant. Results: A total of 810 patients were included in the study, 42.4% males and 57.6% females. They were divided into Group-A, split regimen (n=308); Group B, same day regimen (n= 252); and Group C, previous day regimen (n =250). The average age in the three groups were 57, 57.3 and 59.3 years respectively. The average BMI was 29.6, 29.7 and 28.7 in Group A, B, and C respectively. Comparison of quality of bowel preparation between the three groups showed that the split day regimen had the higher percentage of adequate (adequate = excellent + good) preparation (83%) compared to same day (74%) and previous day regimens (64%). The Adenoma Detection Rate (ADR) was significantly higher in the split day regimen group (18%) compared to the previous day group (11.5%), p = 0.03. Conclusion: Our study shows that split administration of PEG solution provided the higher percentage of adequate (excellent and good) bowel preparation compared to other regimens of PEG administration. It also provided statistically significant higher Adenoma Detection Rate compared to previous day regimen (p= 0.03). The split regimen was observed to provide a higher quality of bowel preparation in people with BMI >30 (Obese) compared to the other regimens of PEG.Table: Table. Comparison of general factors between bowel preparation regimens