Bowel Preparation Regimen Research Articles

Novel regimen for colonoscopy bowel preparation with oral lactulose: a prospective comparative study.

Polyethylene glycol (PEG) is considered the gold standard regimen for bowel preparation; however, due to the necessity of a large volume, patient tolerance is impaired. Therefore, lactulose is a novel alternative for colonoscopy preparation. This study aimed to investigate the efficacy and safety of lactulose-based bowel preparations in comparison with PEG for colonoscopy. This is a prospective, non-blinded, comparative study. Outpatients were randomly divided into two groups: group 1 (111 patients), PEG; and group 2 (111 patients), lactulose. The following clinical outcomes were assessed in each group: degree of bowel clearance using the Boston bowel preparation score, colorectal polyp detection rate, adenoma detection rate, tolerability, and side effects. The rate of inadequate bowel preparation was 8.1% and 1.8% for the PEG and lactulose groups, respectively (p=0.030). The Boston bowel preparation score for the entire colon was 7.34±1.17 and 8.36±1.09 for the PEG and lactulose groups, respectively (p<0.001). The satisfactory overall experience rates were 27.9% and 62.2% for the PEG and lactulose groups, respectively (p<0.001). The novel bowel preparation with oral lactulose was superior to that with PEG in terms of colon cleansing, adenoma detection rate, tolerance, and patient experience.

Evaluation of the Danish Colorectal Cancer Screening Program Among People With Cystic Fibrosis.

We aimed to evaluate the Danish CRC screening program, estimate colonic neoplasia's prevalence, and assess the utilized BP regimens. People with cystic fibrosis (pwCF) have an increased risk of precancerous polyps and colorectal cancer (CRC), with occurrence at an earlier age compared with the general population. Consequently, colonoscopy screening is recommended. PwCF requires specific bowel preparation (BP) regimens to ensure an adequate colonoscopy. We conducted a national retrospective cohort study, which included all pwCF eligible for colonoscopy according to international recommendations in 26 months. Among 119 eligible pwCF, 58 completed colonoscopies during the screening period. The screening was omitted in 25% of pwCF. Among the pwCF undergoing colonoscopy screening, precancerous polyps were found in 24% and none with CRC. One patient developed CRC before being offered screening. Risk factors for neoplasia were old age and male sex. The quality of BP was high, even though most pwCF received standard BP. The best quality was found in nonorgan transplanted, pwCF who received modulator treatment and those with no laxatives use. We detected a high adherence to CRC screening, but also a substantial proportion of pwCF who were not informed about screening recommendations, calling for greater awareness among clinicians. Although lower than previously described, our study revealed high numbers of precancerous polyps and CRC compared with the general population, underlining the need for screening. BP quality remained high, despite frequent use of standard regimens, implicating the need for more individualized regimens before undergoing colonoscopy.

S867 Evaluation of Bowel Preparation Regimens for Colonoscopy in Patients Receiving GLP-1 Receptor Agonists

S867 Evaluation of Bowel Preparation Regimens for Colonoscopy in Patients Receiving GLP-1 Receptor Agonists

Evaluation of the efficacy of polyethylene glycol in combination with different doses of linaclotide in a fractionated bowel preparation for colonoscopy: a prospective randomized controlled study

Background and aimThe ideal bowel cleansing program still needs to be explored. The aim was to compare the bowel cleansing effect and patient tolerance of low-dose polyethylene glycol (PEG) combined with different doses of linaclotide in fractionated bowel preparation.MethodsThe subjects were randomly assigned to the 3LPEG group, 2LPEG + 2L group, or 2LPEG + L group. The primary outcome was to use the Ottawa Bowel Preparation Scale (OBPS) to evaluate the efficacy of bowel cleansing, and the secondary outcomes were the detection rate of adenomas and polyps, adverse reactions, tolerance, and defecation dynamics; subsets of patients with chronic constipation and irritable bowel syndrome were also analyzed.ResultsA total of 753 patients were randomly assigned. In ITT analysis, the success of preparation of the 2LPEG + 2L group was better than that of the 2LPEG + L group or the 3LPEG group (92.0% vs. 82.3% vs. 82.1%; P = 0.002). Compared with the 3LPEG group, the 2LPEG + L group showed similar but non-inferior results (82.3% vs. 82.1%, P > 0.05). The 2LPEG + 2L group was similar to the 2LPEG + L group in terms of adverse reaction, tolerance, willingness to reuse, and sleep quality, but both were superior to the 3LPEG group. In a subgroup analysis of chronic constipation, the 2LPEG + 2L group had the best cleansing effect on the right colon and mid colon, while in the subgroup analysis of irritable bowel syndrome, the tolerance was better in the 2LPEG + 2L group and the 2LPEG + L group than the 3LPEG group.Conclusions2LPEG + 2L is a feasible bowel preparation regimen.

Application of linaclotide in bowel preparation for colonoscopy in patients with constipation: A prospective randomized controlled study.

Colonoscopy plays a crucial role in the early diagnosis and treatment of colorectal cancer. Adequate bowel preparation is essential for clear visualization of the colonic mucosa and lesion detection. However, inadequate bowel preparation is common in patients with constipation, and there is no standardized preparation protocol for these patients. This study aimed to explore the effectiveness and tolerability of a pre-colonoscopy combination regimen of linaclotide and polyethylene glycol (PEG). In this prospective, single-center, randomized controlled trial, 322 participants were divided into two groups: a 3-L PEG+870-μg linaclotide group (administered as a single dose for 3days) and a 4-L PEG group. The primary endpoints were the Boston Bowel Preparation Scale (BBPS) score and the rate of adequate and excellent bowel preparation. Secondary endpoints were the rates of detection of colonic adenomas and polyps, cecal intubation rates, colonoscopy time, adverse reactions, patient satisfaction, and physician satisfaction. The study included 319 patients. The 3-L PEG+linaclotide group showed significantly higher rates of adequate and excellent bowel preparation than the 4-L PEG group (89.4% vs 73.6% and 37.5% vs 25.3%, respectively; P<0.05). The mean BBPS score for the right colon in the 3-L PEG+linaclotide group was significantly higher than that in the 4-L PEG group. There were no significant between-group differences regarding the detection rates of colonic polyps and adenomas (44.4% vs 37.7% and 23.1% vs 20.1%, respectively; P>0.05). There were no significant between-group differences regarding cecal intubation rates, colonoscopy operation, and withdrawal times. However, patient tolerance and sleep quality were better in the 3-L PEG+linaclotide group. The combination of 3-L PEG and 870-μg linaclotide, because of its lower volume of intake, can be considered as an alternative bowel preparation regimen for constipated patients undergoing colonoscopy, especially for the elderly.

Efficacy of linaclotide in combination with polyethylene glycol for bowel preparation in Chinese patients undergoing colonoscopy polypectomy: protocol for a randomised controlled trial

BackgroundAdequate bowel preparation is essential for successful colonoscopy and polypectomy procedures. However, a significant proportion of patients still exhibit suboptimal bowel preparation, ranging from 18% to 35%. The effectiveness of...

Online Educational Module Improves Knowledge of Nurses on Bowel Preparation for Colonoscopy.

The effectiveness of colonoscopy is limited by the adequacy of bowel preparation. Nurses are essential in providing bowel cleansing agents and instructions for hospitalized patients before colonoscopy. This study aims to assess and improve the knowledge of nurses on bowel preparation for inpatient colonoscopy. Participants were asked to complete the survey before and after completing an educational module. The module and survey questions were placed in the NetLearning environment of the hospital intranet. A minimum post-test score of 80% was required to pass the course. A total of 1,107 nurses participated in the survey. Overall, the average score improved from 87% to 93% after the module (p < .0495). Knowledge of the different ways of consuming bowel cleansing agents improved from 54.3% to 83.6% (p = .0001). Only 56.2% of nurses knew how to carry out a split-dose bowel preparation regimen, which increased to 80.1% after the educational module (p = .0001). Nurses' knowledge about the different ways of consuming bowel cleansing agents before colonoscopy and the split-dose regimen is inadequate. A simple online educational module significantly improved the knowledge of nurses on bowel preparation for colonoscopy.

Effect of chewing gum in bowel preparation for patients undergoing small bowel and colon capsule endoscopy: Systematic review with meta-analysis.

Background and study aims Quality of bowel preparation and successful transit are critical factors for complete small bowel capsule endoscopy (SBCE) and colon capsule endoscopy (CCE). The aim of this systematic review with meta-analysis was to assess the impact of chewing gum as part of the bowel preparation regimen on the completion rate in both SBCE and CCE. Methods A systematic literature search was conducted in PubMed, Cochrane, Web of Science and Embase. Data were extracted upon quality assessment of included studies. Two reviewers conducted the screening process according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Eighty-four studies met the search criteria and four randomized controlled trials were included in the meta-analysis, these were assessed for bias using Minors. Pooled completion rate of SBCE studies was defined as the primary outcome. Results Three randomized controlled trials were SBCE studies and one was a CCE study. The pooled completion rate (91%) was not significantly higher in SBCE patients who were given chewing gum after capsule ingestion compared to those who were not (85%). Variance information was not reported in all studies, and therefore, pooled transit time estimates could not be calculated. Conclusions Chewing gum has a good safety profile but has only been used as a booster in one CCE study and a few SBCE studies. More prospective randomized controlled trials, therefore, are needed to investigate the efficacy of chewing gum for achieving complete capsule examination.

A Randomized Controlled Trial Comparing Polyethylene Glycol with Sodium Phosphate for Gut Preparation in children undergoing Proctoscopy

Background: The outcome of diagnostic and therapeutic procedures such as proctoscopy, colonoscopy, and endoscopy relies on thorough bowel preparation, ensuring a complete view of the colonic mucosa. Aim: To compare polyethylene glycol with sodium phosphate for gut preparation in children undergoing proctoscopy. Methods: We conducted a study on pediatric patients aged 3 to 14 years who underwent elective proctoscopy. The study took place in the pediatric surgical ward of Mayo Hospital, Lahore, following approval from the hospital's Ethical Committee. We educated the parents or guardians of patients preoperatively about the use of bowl preparatory agents, their effectiveness, outcomes, side effects, complications, and informed consent. We divided the children into two groups to determine the method of bowl preparation. Patients in Group 'A' underwent bowl preparation using polyethylene glycol. Results: There were 60 patients, with 30 in each group. Patients in Group 'A' were given bowl preparation with polyethylene glycol. Before the proctoscopy, the patients underwent a 1-day PEG 3350 bowel preparation regimen. While group B had bowel preparation with sodium phosphate enema, the patients' mean ages were 4.46 years. In group A, there were 16 males and 14 females, while in group B, there were 19 males and 11 females. In group A, 11 patients demonstrated excellent compliance, 12 showed partial compliance, and 7 showed poor compliance with polyethylene glycol. While in group B, 22 patients showed excellent compliance, and 8 patients showed good compliance. Practical Implication: The study suggests that both polyethylene glycol (PEG) and sodium phosphate enema are suitable for pediatric patients undergoing proctoscopy. However, compliance rates vary between the two methods. Patients in group A showed varying levels of compliance, while those in group B showed higher compliance. Therefore, healthcare providers should consider sodium phosphate enema for improved patient adherence and procedural outcomes. This highlights the importance of assessing compliance rates for informed decision-making. Conclusion: In our experience, sodium phosphate enema was superior to oral polyethylene glycol in terms of compliance and adequacy of gut preparation. There were also fewer side effects with the sodium phosphate enema. Keywords: Polyethylene glycol, proctoscopy, gut preparation

Efficacy and safety of oral sulfate tablet vs. polyethylene glycol and ascorbate for bowel preparation in children.

Bowel preparation for pediatric colonoscopy presents several challenges. However, no bowel preparation regimen is universally preferred for children. We aimed to investigate the efficacy and safety of oral sulfate tablet (OST) in pediatric bowel preparation. This study retrospectively analyzed data from children who received 2l of polyethylene glycol and ascorbate (PEG/Asc) or OST for bowel preparation between 2021 and 2023. A comparative analysis was conducted between the two groups. A total of 146 patients were included (2l PEG/Asc: 115, 73.0% vs. OST: 31). No significant difference was observed in the total BBPS score (median 8.0 vs. 8.0, P = 0.152) and the total OBPS score (median 5.0 vs. 3.0, P = 0.152) between the two groups. No significant difference was noted in the ratio of a bubble score of 0 (73.0% vs. 93.5%, P = 0.132). The incidence of abdominal pain was significantly lower in the OST group (32.2% vs. 3.2%, P = 0.002). The VAS score for overall satisfaction was significantly higher in the OST group (4.0 vs. 7.0, P < 0.001). For the next colonoscopy bowel preparation, a higher proportion of patients in the OST group showed a willingness to use the same preparation regimen (33.9% vs. 83.9%, P < 0.001). OST was as efficacious and safe as 2 L of PEG/Asc for pediatric bowel preparation. The satisfaction level was higher with OST than with 2 L of PEG/Asc. OST may be considered a good alternative for children with poor compliance during bowel preparation.

One-day versus three-day low-residue diet bowel preparation regimens before colonoscopy: a meta-analysis of randomized controlled trials.

Although studies have shown that the quality of bowel preparation with low-residue diet (LRD) is as effective as that of clear fluid diet (CLD), there is currently no consensus on how long an LRD should last. The aim of this study was to compare a 1-day versus 3-day LRD on bowel preparation before colonoscopy. A systematic review search was conducted in MEDLINE/PubMed, EMBASE, Web of Science, and Cochrane database from inception to April 2023. We identified randomized controlled trials (RCTs) that compared 1-day with 3-day LRD bowel cleansing regiments for patients undergoing colonoscopy. The rate of adequate bowel preparation, polyp detection rate, adenoma detection rate, tolerability, willingness to repeat preparation, and adverse events were estimated using odds ratios (OR) and 95% confidence interval (CI). We also performed meta-analysis to identify risk factors and predictors of inadequate preparation. Four studies published between 2019 and 2023 with 1927 participants were included. The present meta-analysis suggested that 1-day LRD was comparable with 3-day LRD for adequate bowel preparation (OR 0.89; 95% CI, 0.65-1.21; P=0.45; I2=0%; P=0.52). The polyp detection rate (OR 0.94; 95% CI, 0.77-1.14; P=0.52; I2=23%; P=0.27) and adenoma detection rate (OR 0.87; 95% CI, 0.71-1.08; P=0.21; I2=0%; P=0.52) were similar between the groups. There were significantly higher odds of tolerability in patients consuming 1-day LRD compared with 3-day LRD (OR 1.64; 95% CI, 1.13-2.39; P<0.01; I2=47%; P=0.15). In addition, constipation was identified as the independent predictor of inadequate preparation (OR 1.98; 95% CI, 1.27-3.11; P<0.01; I2=0%; P=0.46). The present study demonstrated that a 1-day LRD was as effective as a 3-day CLD in the quality of bowel preparation before colonoscopy and significantly improved tolerability of patients. In addition, constipation is an independent risk factor of poor bowel preparation, and the duration of LRD in patients with constipation still needs further clinical trials.

Effectiveness and safety of Shankhaprakshalana-a yogic technique-in bowel preparation for colonoscopy: A retrospective study.

Shankhaprakshalana (SP) is a yogic method aiming to cleanse the bowel. It involves the use of warm saline water and a combination of five asanas. This study was designed to assess the effectiveness and safety of bowel preparation by SP. This is a retrospective observational study of prospectively collected data. Patients planned for colonoscopy were screened and enrolled to undergo bowel preparation by SP on the day of the colonoscopy. Patients having comorbid conditions, poor performance status, suspected or previously diagnosed intestinal stricture and past history of major abdominal surgery and those unable to perform asanas of SP were excluded. A low-fiber diet was advised for one day before the colonoscopy. Patients were advised to drink 400mL of lukewarm saline water followed by five asanas (exercises) of SP, each done eight times dynamically and sequentially. After completing six such cycles, patients underwent colonoscopy. Boston Bowel Preparation Scale (BBPS) score was used to assess the quality of bowel preparation. Total 238 patients were included. The major indications for colonoscopy were abdominal pain (35.3%), hematochezia (23.9%), diarrhea (20.2%), constipation (10.9%) and anemia (9.7%). The mean age was 37.7 (± 12) years. The mean BBPS was 8 (± 1.2). Bowel preparation was inadequate (BBPS < 6) in only two patients. Mean segmental BBPS for the three segments of the colon (right, transverse and left) was 2.6 (± 0.5), 2.7 (± 0.4) and 2.6 (± 0.7), respectively. Minor adverse events (nausea, abdominal pain, vomiting, giddiness and bloating) were noted in 10 participants (4.2%), which did not require hospitalization. Bowel preparation was completed in 133 (± 35) minutes. Shankhaprakshalana is an effective and safe method to achieve adequate bowel preparation before colonoscopy. Since this is a single-center and retrospective study, future multi-centric, prospective studies comparing it with the standard bowel preparation regimens are warranted.

3 L split-dose polyethylene glycol is superior to 2 L polyethylene glycol in colonoscopic bowel preparation in relatively high-BMI (≥ 24 kg/m2) individuals: a multicenter randomized controlled trial

BackgroundWhether body mass index (BMI) is a risk factor for poor bowel preparation is controversial, and the optimal bowel preparation regimen for people with a high BMI is unclear.MethodsWe prospectively included 710 individuals with high BMIs (≥ 24 kg/m2) who were scheduled to undergo colonoscopy from January to November 2021 at 7 hospitals. Participants were randomly allocated into 3 L split-dose polyethylene glycol (PEG) group (n=353) and 2 L PEG group (n=357). The primary outcome was the rate of adequate bowel preparation, and the secondary outcomes included Boston Bowel Preparation Scale (BBPS) score, polyp detection rate, cecal intubation rate, and adverse reactions during bowel preparation. Furthermore, we did exploratory subgroup analyses for adequate bowel preparation.ResultsAfter enrollment, 15 individuals didn’t undergo colonoscopy, finally 345 participants took 3 L split-dose PEG regimen, and 350 participants took 2 L PEG regimen for colonoscopic bowel preparation. 3 L split-dose PEG regimen was superior to 2 L PEG regimen in the rate of adequate bowel preparation (81.2% vs. 74.9%, P = 0.045), BBPS score (6.71±1.15 vs. 6.37±1.31, P < 0.001), and the rate of polyp detection (62.0% vs. 52.9%, P = 0.015). The cecal intubation rate was similar in both groups (99.7%). Regarding adverse reactions, individuals were more likely to feel nausea in the 3 L PEG group (30.9% vs. 19.3%; P = 0.001); however, the degree was mild. In the subgroup analysis for adequate bowel preparation, 3 L split-dose PEG regimen performed better than 2 L PEG regimen in the overweight (BMI 25-29.9 kg/m2 ) (P = 0.006) and individuals with constipation (P = 0.044), while no significant differences were observed in relatively normal (BMI 24-24.9 kg/m2) (P = 0.593) and obese individuals (BMI ≥ 30 kg/m2) (P = 0.715).Conclusions3 L split-dose PEG regimen is superior to 2 L PEG regimen for colonoscopic Bowel Preparation in relatively high-BMI individuals, especially overweight individuals (BMI 25-29.9 kg/m2 ).Trial RegistrationThis trial was registered in the Chinese Clinical Trials Registry (ChiCTR2000039068). The date of first registration, 15/10/2020, http://www.chictr.org.cn

Linaclotide combined with polyethylene glycol regimen for bowel preparation in patients with chronic constipation: A prospective randomized controlled study

Linaclotide combined with polyethylene glycol regimen for bowel preparation in patients with chronic constipation: A prospective randomized controlled study

Bowel preparation in children and adolescents undergoing ileo-colonoscopy: what is new?

Ileo-colonoscopy is a vital diagnostic and therapeutic tool undertaken for evaluating and treating gastrointestinal tract pathologies in children and adolescents as well as adults. Proper visualization of the lower intestinal mucosa, completion of the procedure including terminal ileum/cecal intubation, detection of pathological lesions and therapeutic maneuvers are hinged on how adequate the bowel preparation is. About 25% percent of pediatric patients have inadequate bowel preparations, which can lead to prolonged colonoscopy procedure time, missed pathology, difficult ileal intubation/incomplete examination, and requiring cancellation or repeat procedure with attendant anesthetic risks. An ideal bowel preparation regimen should clear the colon of fecal material with no alteration of the colonic mucosa that could affect the histological findings. There is no acceptable universal regimen for bowel preparation in children; however wide variability of practices exists globally. Hence, the current review is aimed at analyzing recent published literature and personal practical experiences as well as developing a standard bowel preparation guideline that will improve outcome of the ileo- colonoscopy procedure in children particularly in resource limited settings.

MR Elastography of the Pancreas: Bowel Preparation and Repeatability Assessment in Pancreatic Cancer Patients and Healthy Controls.

Pancreatic ductal adenocarcinoma (PDAC) stromal viscoelasticity can be measured using MR elastography (MRE). Bowel preparation regimens could affect MRE quality and knowledge on repeatability is crucial for clinical implementation. To assess effects of four bowel preparation regimens on MRE quality and to evaluate repeatability and differentiate patients from healthy controls. Prospective. 15 controls (41 ± 16 years; 47% female), 16 PDAC patients (one excluded, 66 ± 12 years; 40% female) with 15 age-/sex-matched controls (65 ± 11 years; 40% female). Final sample size was 25 controls and 15 PDAC. 3-T, spin-echo echo-planar-imaging, turbo spin-echo, and fast field echo gradient-echo. Four different regimens were used: fasting; scopolaminebutyl; drinking 0.5 L water; combination of 0.5 L water and scopolaminebutyl. MRE signal-to-noise ratio (SNR) was compared between all regimens. MRE repeatability (test-retest) and differences in shear wave speed (SWS) and phase angle (ϕ) were assessed in PDAC and controls. Regions-of-interest were defined for tumor, nontumorous (n = 8) tissue in PDAC, and whole pancreas in controls. Two radiologists delineated tumors twice for evaluation of intraobserver and interobserver variability. Repeated measures analysis of variance, coefficients of variation (CoVs), Bland-Altman analysis, (un)paired t-test, Mann-Whitney U-test, and Wilcoxon signed-rank test. P-value<0.05 was considered statistically significant. Preparation regimens did not significantly influence MRE-SNR. Therefore, the least burdensome preparation (fasting only) was continued. CoVs for tumor SWS were: intrasession (12.8%) and intersession (21.7%), and intraobserver (7.9%) and interobserver (10.3%) comparisons. For controls, CoVs were intrasession (4.6%) and intersession (6.4%). Average SWS for tumor, nontumor, and healthy tissue were: 1.74 ± 0.58, 1.38 ± 0.27, and 1.18 ± 0.16 m/sec (ϕ: 1.02 ± 0.17, 0.91 ± 0.07, and 0.85 ± 0.08 rad), respectively. Significant differences were found between all groups, except for ϕ between healthy-nontumor (P = 0.094). The proposed bowel preparation regimens may not influence MRE quality. MRE may be able to differentiate between healthy tissue-tumor and tumor-nontumor. 2 TECHNICAL EFFICACY STAGE: 2.

Identifying the need for a UK colorectal cancer screening programme for patients with cystic fibrosis (CF): 10-year retrospective review of colonoscopy and colorectal cancer outcomes at a single CF centre

ObjectivePatients with cystic fibrosis (pwCF) have a high incidence of early colorectal cancer (CRC). In the absence of a UK CRC screening programme for pwCF, we evaluated the utility and...

Preoperative oral antibiotic bowel preparation regimens in radical cystectomies with continent diversion.

e16610 Background: Bowel preparation regimens (BRs) were historically standard before radical cystectomy (RC) with urinary diversion to decrease infection and anastomotic breakdown. However, the Enhanced Recovery After Surgery protocol (ERAS) no longer includes BRs. Recent data show that BRs may exacerbate frailty, worsen surgical outcomes, and prolong recovery. Importantly, however, previous studies did not stratify by diversion type. We performed a population-based analysis of preoperative oral antibiotic BRs (OABRs) with RC, alongside subgroup analyses to compare outcomes by diversion type. Methods: RCs performed from 2019-2020 were identified using the new NSQIP Cystectomy-Targeted PUF. Captured variables included OABR, diversion type, demographics, comorbidities, and perioperative outcomes. Univariate analysis with two tailed chi square and t tests was performed to compare baseline characteristics, 30-day mortality, and complications. Multivariable logistic regression with stepwise-backward-elimination (p &gt; 0.25) adjusted for mechanical BRs, operative approach, comorbidities, functional status, demographics, ASA class, labs, and staging. Results: In total, 3,894 RCs were performed, of which 357 (9.2%) included OABR. There were no significant baseline differences between the OABR and the non-OABR cohorts. On univariate analysis, OABR patients had increased operative time, length of stay (LOS), minor complications, and bleeds. On subgroup analysis, ileal conduit patients experienced higher rates of the 4 aforementioned outcomes plus deep wound infections and NGT use. However, the continent diversion subgroup was not associated with increased operative time, LOS, or any complications. Continent diversion had significantly lower rates of sepsis and ureteral fistula formation. Upon multivariable adjustment, OABR was not associated with increased rates of any complications across any subgroup. OABR did confer significantly decreased odds of sepsis in continent diversion patients. Conclusions: Supporting ERAS recommendations, this study showed that pre-RC OABRs do not improve outcomes and increase LOS for ileal conduits. However, this study uniquely included continent diversions, such as neobladders and Indiana pouches. Importantly, in continent diversion patients, OABR did not increase LOS or complications while decreasing sepsis rates. These findings suggest possible utility of OABR before RC with continent diversion.

P292 The effectiveness of pre-colonoscopy bowel preparation for colorectal cancer screening in patients with cystic fibrosis in Wales

The Colorectal Cancer Screening Consensus Recommendations state that patients with Cystic Fibrosis (PwCF) undergoing colonoscopy should receive intensive inpatient bowel preparation regimes for optimal examination. We assessed the effectiveness of the bowel preparation regimes used in PwCF attending the All Wales Adult Cystic Fibrosis Centre (AWACFC) to help inform future intervention.

Effect of preoperative oral antibiotics and mechanical bowel preparation on the prevention of surgical site infection in elective colorectal surgery, and does oral antibiotic regime matter? a bayesian network meta-analysis.

Surgical site infection (SSI) impacts 5-20% of patients after elective colorectal surgery. There are varying reports on the effectiveness of oral antibiotics (OAB) with preoperative mechanical bowel preparation (MBP) in preventing SSI. We aim to determine the role of OAB and MBP in preventing SSI after elective colorectal surgery. We also determine if a specific OAB regimen will be more effective than others. This study investigated the impact of OAB and MBP in patients undergoing elective colorectal surgery. PubMed, MEDLINE, Ovid, Cochrane Central Register of Controlled Trials, ACP Journal Club, and Embase databases were searched for randomized clinical trials (RCTs) published by June 2022. All RCTs comparing various preoperative bowel preparation regimens, including pairwise or multi-intervention comparisons, were included. To establish the role of OAB and MBP in preventing SSI, we conducted a Bayesian network meta-analysis on all RCTs. We further performed subgroup analysis to determine the most effective OAB regimen. Among included 46 studies with a total of 12690 patients, patients in the MBP + OAB group were less likely to have SSI than those having MBP-only (OR 0.55, 95% CrI 0.39-0.76), and without MBP and OAB (OR 0.52, 95% CrI 0.32-0.84). OAB regimen C (kanamycin + metronidazole) and A (neomycin + metronidazole) demonstrated a significantly reduced incidence of SSI, compared to regimen B (neomycin + erythromycin) with OR 0.24 (95% CrI 0.07-0.79) and 0.26 (95% CrI 0.07-0.99) respectively. OAB with MBP reduces the risk of SSI after elective colorectal surgery. Providing adequate aerobic and anaerobic coverage with OAB may confer better protection against SSI.