P200 Oral Mannitol for bowel preparation in IBD patients: a post-hoc analysis of a multicentre, controlled, randomized clinical trial

Abstract

Abstract Background Bowel preparation is the most burdensome part of the whole colonoscopy procedure according to patients. A diagnosis of Inflammatory Bowel Disease (IBD) implies the need for lifelong repeated colonoscopies, therefore amplifying the problem. Bowel preparation with oral Mannitol, a sugar alcohol with a sweet taste, could significantly improve the patients’ tolerance as it has a quick onset, is single dose and has a low volume.1-3 Methods This is a post-hoc analysis of IBD patients included in the SATISFACTION study, a third phase multicentre, international, randomized, endoscopists-blinded controlled trial4. Patients were randomized (1:1) to 750mL of oral mannitol (OM, 100 g in 750 mL water) to be drunk in a single dose 4 hours before colonoscopy versus a standard split preparation with 2L PEG-ASC (PEG). An intention to treat analysis was performed on patients who underwent colonoscopy and who took bowel preparation even partially. Biological important parameters summarising the rate of bowel cleansing and patients’ satisfaction were collected. Results A total of 55 IBD patients (M = 24, P = 31, Crohn’s = 12, Ulcerative Colitis = 40, Microscopic colitis =3) from 7 centres were ruled in for this post-hoc analysis. The two population were comparable in terms of age and sex and diseases (Table 1). A statistically significant preference of OMl over PEG was found in terms of taste (numerical rating scale – NRS, p < 0.001), willingness to reuse the preparation (p = 0.03), and of time of first evacuation (M 56.6 minutes, P 90.7, p = 0.01). No differences were found in terms of adequate bowel cleansing as assessed by the Boston bowel preparation scale (96% OM, 97% PEG), adherence to bowel preparation (complete in 100% OM, 94% PEG) and easy of use (88% OM, 71% PEG). Minor and expected adverse events of special interest such as nausea and abdominal pain were comparable in the two courts (12% OM, 3% PEG). Conclusion Bowel preparation with a very low volume of oral mannitol in a single dose 4 h before colonoscopy provides better satisfaction among IBD patients and showed an excellent efficacy and safety profile as compared to the standard split preparation with 2L PEG-ASC. Same day bowel preparation with oral mannitol is a reliable option for colonoscopy in IBD and an effective strategy to improve the patients’ acceptance. Funding/Acknowledgment The Satisfaction study was funded by NTC, Milan, Italy.