P698 IBD patients equally tolerate bowel preparation but need higher doses of sedation during colonoscopy in comparison with a population screening programme: Results from a prospective, single-centre study

Abstract

Abstract Background IBD patients are intended to undergo several times colonoscopy during their lifespan. Adequate bowel preparation and sedation greatly contribute to high-quality colonoscopy and are even more important in this setting. However, few and low-quality studies addressed these issues. Aims: to prospectively evaluate the tolerability of bowel preparation and colonoscopy in ulcerative colitis (UC) and Crohn’s disease (CD) patients compared with subjects participating in a colorectal cancer population screening programme. Methods we consecutively enrolled CD and UC patients and screening subjects (SS) undergoing colonoscopy between August 2017 and August 2019. Bowel preparation was done by macrogol 4.000 + simethicone + sodium-sulphate-anhydrous. We recorded endoscopic, clinical and demographic features; quality of cleansing by Boston Bowel Preparation Scale (BBPS; from 0 the worst to 9 the best); sedation dose and need to increase the initial doses of midazolam (3.0 mg) and fentanyl (0.05 mg). Tolerability of bowel preparation, discomfort and pain during colonoscopy were assessed by Visual Analogue Scale (VAS) from 0 to 100 mm. Results 65 UC (26 women, mean age 50.6 ± 15.4 years), 65 CD (29 women, mean age 44.7 ± 3.9) and 94 SS (47 women, mean age 61.9 ± 6.9) enrolled. Bowel preparation was similarly tolerated in UC (70.3 ± 17.7 mm), CD (73.1 ± 12.7 mm) and SS (73.2 ± 12.6 mm) (p = 0.397). Complete colonoscopy was similarly done in UC (61/65, 93.8%), CD (60/65, 92.3%) and SS (91/94, 96.8%) (p = 0.364). BBPS did not show significant differences between UC (6.5 ± 1.0), CD (6.4 ± 1.1) and SS (6.4 ± 1.0) (p = 0.824). The need to increase sedation doses was significantly higher in CD (26/65, 40.0%) and UC (16/65, 24.6%) than in SS (4/94, 4.3%) (p < 0.0001). The mean increases in midazolam and fentanyl doses were significantly higher in CD (0.446 ± 0.660 mg and 0.009 ± 0.019 mg, respectively) and UC (0.300 ± 0.620 and 0.008 ± 0.018 mg) than in SS (0.042 ± 0.250 mg and 0.001 ± 0.007 mg) (p < p < 0.0001 in both cases). Discomfort and pain during colonoscopy were similar in UC (35.0 ± 23.0 mm and 27.6 ± 24.6 mm, respectively), CD (37.5 ± 22.2 mm and 28.8 ± 22.5 mm) and SS 33.7 ± 18.7 and 26.9 ± 19.8 mm) (p = 0.530 and p = 0.866, respectively). Conclusion in IBD patients, higher sedation doses are needed in order to warrant a tolerated colonoscopy. Bowel preparation is equally tolerated and efficacious in IBD patients and in screening subjects.