Split-dose Polyethylene Glycol Research Articles

Phosphate tablets or polyethylene glycol for preparation to colonoscopy? A multicentre non-inferiority randomized controlled trial.

Adequate bowel preparation is a crucial step in colonoscopy procedure and has been identified as the cornerstone of a quality colonoscopy. Polyethylene glycol (PEG) for bowel cleansing still had up to 10% unprepared colon. We herein compare efficacy, acceptability, tolerance and safety of sodium phosphate (NaP) tablets and split-dose PEG for bowel cleansing. A prospective non-inferiority randomized trial was performed and registered on www.clinicaltrials.gov (NCT01840553). Patients were randomized to either 32 NaP tablets or 4L of PEG. Blind readers assessed the efficacy of colon cleansing using the Boston Bowel Preparation Scale (BBPS). A total of 461 patients were randomized in groups (NaP group: n=231; PEG group: n=230). Median age was 54 and 52 in NaP group and PEG group, respectively (p<0.01). Patients experienced an overall compliance to the treatment in 99.6 and 94.1% in the NaP group and in the PEG group, respectively (p<0.001). The mean time of withdrawal was 15.1±8.9 and 15.4±9.5min in the NaP group and in the PEG group, respectively (p=0.95). The good quality of bowel preparation, defined as BBPS score ≥7, was obtained in 86.4 and 89.0% of cases in the NaP group and in the PEG group, respectively (p=0.42). In all segment (right colon, transverse colon and left colon and rectum), the NaP group was non-inferior to the PEG group. Bowel prep regimen was more frequently considered as "easy" by patients from the NaP group (54.8% of patients) than patients from the PEG group (29.0% of patients; p<0.001). No serious adverse events were reported. No statistical differences were found between the NaP group and the PEG group concerning the incidence of an adverse event (338 vs. 322, respectively). While NaP tablets appeared as efficient as PEG in terms of colon cleansing prior to a colonoscopy, they significantly improved the overall compliance and eased product administration. At an era where bowel cleansing appears to be the cornerstone of a quality colonoscopy, NaP tablets in patients without contraindication might be considered as an option.

Predictors of Suboptimal Bowel Preparation Using 3-l of Polyethylene Glycol for an Outpatient Colonoscopy: A Prospective Observational Study.

A 3-l polyethylene glycol (PEG) solution provided better bowel cleansing quality than a 2-l solution for outpatient colonoscopy. Predictors of suboptimal preparation using a 3-l PEG have not been previously reported. To investigate the possible predictors of suboptimal bowel preparation using 3-l of PEG. We analyzed a database of 1404 consecutive colonoscopies during a 27-month period at a community hospital. A split-dose PEG regimen was provided for morning colonoscopies, and a same-day PEG regimen was provided for afternoon colonoscopies. The level of bowel cleansing was prospectively scored according to the Boston Bowel Preparation Scale (BBPS). Possible predictors of suboptimal colon preparation, defined as a BBPS score <7, were analyzed using univariate statistics and multivariate logistic regression models. The mean age of the study population (46.7% men) was 52.5years (range 20-80years, SD 11.1years), and the majority of patients (77.6%) underwent morning colonoscopies. A suboptimal bowel preparation was reported in 17.2% of the observed colonoscopies. In the multivariate regression analysis, constipation (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.15-2.22), male gender (OR 1.68, 95% CI 1.25-2.25), obesity (OR 1.76, 95% CI 1.29-2.41), and inadequate (<80%) PEG consumption (OR 5.4, 95% CI 2.67-10.89) were independent predictors of a suboptimal colon preparation. This prospective study identified that constipation, male gender, obesity, and inadequate intake of PEG were significant risk factors for suboptimal bowel preparation using a 3-l PEG solution for outpatient colonoscopy. Interventions of optimized colonoscopy preparation should be targeted at these patient populations.

Split-Dose Polyethylene Glycol Is Superior to Single Dose for Colonoscopy Preparation: Results of a Randomized Controlled Trial.

Background. The efficacy of colonoscopy in detecting abnormalities within the colon is highly dependent on the adequacy of the bowel preparation. The objective of this study was to compare the efficacy, safety, and tolerability of PEG lavage and split-dose PEG lavage with specific emphasis on the cleanliness of the right colon. Methods. The study was a prospective, randomized, two-arm, controlled trial of 237 patients. Patients between the age of 50 and 75 years were referred to an outpatient university screening clinic for colonoscopy. Patients were allocated to receive either a single 4 L PEG lavage or a split-dose PEG lavage. Results. Overall, the bowel preparation was superior in the split-dose group compared with the single-dose group (mean Ottawa score 3.50 ± 2.89 versus 5.96 ± 3.53; P < 0.05) and resulted in less overall fluid in the colon. This effect was observed across all segments of the colon assessed. Conclusions. The current study supports use of a split-dose PEG lavage over a single large volume lavage for superior bowel cleanliness, which may improve polyp detection. This trial is registered with ClinicalTrials.gov identifier NCT01610856.

Low-residue breakfast during the preparation for colonoscopy using a polyethylene glycol electrolyte solution: a randomised non-inferiority trial

GoalsTo test the hypothesis that the use of a low-residue breakfast (LRB) the day prior to colonoscopy was not inferior to consuming clear fluids alone (CFD) in patients undergoing outpatient...

Cost-analysis model of colonoscopy preparation using split-dose reduced-volume oral sulfate solution (OSS) and polyethylene glycol with electrolytes solution (PEG-ELS)

Objective:The study aimed to (1) develop a cost model for colonoscopy preparation among patients referred for colonoscopy using split-dose reduced-volume oral sulfate solution (OSS) and generic polyethylene glycol with electrolytes solution (PEG-ELS), (2) examine cost savings associated with OSS vs PEG-ELS, and (3) assess the robustness of the cost model.Methods:Efficacy of each agent was based on the results of a 541-patient clinical trial comparing OSS to PEG-ELS. Cleansing agent and colonoscopy procedure costs were calculated from OptumHealth Reporting & Insights claims data for 2010–Q12013. In the model, patients’ colonoscopies were tracked over a 25 or 35 year time period until the patients reached age 75. The difference per patient per year (PPPY) in total cleansing agent and colonoscopy procedure costs over the time horizon between the OSS and PEG-ELS cohort was calculated. One-way sensitivity analyses were conducted to test the robustness of the cost model.Results:The model showed lower cost for OSS patients over the time horizon. Total PPPY costs were $280.34 for the OSS cohort and $296.36 for the PEG-ELS cohort, resulting in a cost saving of $16.01 PPPY for the OSS cohort. This was due primarily to OSS patients having fewer colonoscopies (OSS: 0.158 vs PEG-ELS: 0.170 PPPY). Over the time horizon, cost savings of $4 763 335 were observed among 10, 000 OSS patients. Cost savings switched from OSS to PEG-ELS cohort in four cases: (1) base-case cost of a completed colonoscopy decreased by 75%, (2) base-case cost of OSS increased to over $143 per usage, (3) all non-completers were lost to follow-up, and (4) OSS bowel preparation quality dropped below PEG-ELS to 70%.Conclusions:From a payer’s perspective, the model showed that the use of OSS as the cleansing agent resulted in potential cost savings compared with PEG-ELS. Cost savings under OSS remained under various sensitivity analyses.

Single‐day sodium picosulfate and magnesium citrate versus split‐dose polyethylene glycol for bowel cleansing prior to colonoscopy: A prospective randomized endoscopist‐blinded trial

The intake of polyethylene glycol (PEG) prior colonoscopy is frequently associated with nausea and abdominal discomfort. The aim of this study was to investigate whether sodium picosulfate and magnesium citrate (PMC) is superior to a polyethylene glycol (PEG) preparation in regard to patient acceptance. Furthermore, it investigates possible differences in efficiency and patient safety. In a randomised, prospective, and endoscopist-blinded study patients were 1:1 randomized to either use PMC or 4-L PEG in order to prepare for colonoscopy. Cleansing regimes consisted of a split-dose administration in the PEG arm and standard administration in the PMC arm. Primary end point was proportion of patients evaluating the bowel preparation procedure as "very distressing," defined as ≥ 8 points on a 10-point numeric rating scale (NRS). Secondary end points were quality of bowel preparation and electrolyte parameters. PMC bowel-cleansing procedure was better tolerated compared with PEG (PMC(NRS<8) = 89.9% vs PEG(NRS<8) = 79.2%, P = 0.037). Mean declines in serum sodium (ΔSodium(PEG) = -0.76 ± 3.07 vs ΔSodium(PMC) = -3.38 ± 3.56 mmol/L; P < 0.001), chloride (ΔChloride(PEG) = -1.00 ± 3.22 vs ΔChloride(PMC) = -3.49 ± 3.51 mmol/L; P < 0.001), and osmolality (ΔOsmolality(PEG) = -4.23 ± 6.82 vs ΔOsmolality(PMC) = -8.83 ± 7.43 mosmol/kg; P < 0.001) were higher in the PMC arm than in the PEG arm. Hyponatremia after bowel preparation occurred more often in PMC (21.2%) than in PEG (4.0%) (P < 0.001). Successful preparation was achieved more frequently in the PEG arm (42.9% vs 82.2%; P < 0.001). Standard picosulfate/magnesium citrate is better accepted than a split-dose PEG regimen. From the perspective of successful preparation and patients' safety, PEG is superior to PMC.

Enhancing Bowel Preparation for Screening Colonoscopy: An Evidence-based Literature Review

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. CRC is preventable through the detection and removal of precancerous polyps during colonoscopy and is curable if diagnosed in the early stages. Successful completion of colonoscopy depends on the quality of the bowel preparation. However, the amount of fluid consumption limits patients' ability to comply frequently, resulting in inadequate bowel preparation. Therefore, an extensive literature review was conducted to evaluate currently available bowel preparation products. The results indicated that a 2-L split-dose polyethylene glycol solution provided better patient compliance and tolerability.

Su1680 First Clinical Evaluation of a Novel Method of Bowel Cleansing Before Colonoscopy, by Intrarectal Infusion of Water: Results of a Randomized Comparative Trial a 4L Split-Dose PEG Protocol

Bowel cleansing before colonoscopy is currently based upon oral administration of lavage solutions of polyethylene glycol (PEG) or NaP with large amounts of fluids ingested in a splitted manner. This prospective randomized study compared a split-dose PEG cleansing protocol and a new method of bowel cleansing by low-pressure water infusion into the colon (Prep System, Angel of Water - Lifestream®, Austin, TX).

Su1521 Inadequate Bowel Cleansing Efficacy of Split-Dose Polyethylene Glycol in Diabetic Patients for Colonoscopy: a Prospective and Blinded Trial

Su1521 Inadequate Bowel Cleansing Efficacy of Split-Dose Polyethylene Glycol in Diabetic Patients for Colonoscopy: a Prospective and Blinded Trial Young Hwan Kim*, Eun Hee Seo, Seung Heon Lee, Jae Seung Lee, Sung Ho Choi, Hee Seung Park Division of Gastroenterology, Department of Internal Medicine, Busan St. Mary’s Hospital, Busan, Korea (the Republic of) Background/Aims: The split-dose PEG is considered the standard bowel preparation regimen for colonoscopy. The aim of the present study was to compare the efficacy and tolerability of split-dose PEG for diabetic versus non-diabetic patients who underwent scheduled colonoscopy. Methods: Single-center, prospective, investigatorblinded study. A total of 50 consecutive non-diabetic and 45 consecutive diabetic patients requiring colonoscopy were instructed to ingest 2L PEG solution on the day before the procedure and then 2L of the solution on the day of colonoscopy. The quality of bowel preparation was graded using the Ottawa scale, including cleanliness and fluid quantity. The patient tolerability was assessed using a patient questionnaire. Results: There was a significant difference between diabetic and nondiabetic patients for bowel preparation quality using Ottawa scale, with a worse preparation except mid colon in the diabetic group (total score;7.20 1.64 vs. 5.40 1.96, p! 0.001, right colon; 2.31 0.56 vs. 1.76 0.72, p! 0.001, mid colon; 1.71 0.55 vs. 1.54 0.64, pZ0.170, rectosigmoid colon; 1.78 0.74, p!0.001, fluid volume; 1.40 0.54 vs. 1.00 0.61, pZ0.001). A total of 72% (36/50) of the nondiabetic patients had an adequate preparation (total Ottawa score % 6) compared with only 38% (17/45) of the diabetic patients (PZ 0.001). Patient compliance and incidence of adverse events were not significantly different between the two groups. There was no difference regarding polyp and adenoma detection rate. In the diabetic group, inadequate bowel preparation (total Ottawa score O6) had a significant association with fasting plasma glucose (FPG) (mean FPG of group with inadequate bowel preparation vs. adequate bowel preparation; 136.4 22.5 vs. 121.9 21.0, PZ0.037). But other factors including age, duration of DM, requirement of insulin, HbA1c and late complication including nephropathy, retinopathy and neuropathy had no relationship with inadequate bowel preparation. Conclusion: Although diabetic patients were tolerable to split-dose PEG preparation regimen as non-diabetic patients, they had a worse preparation quality compared with non-diabetic patients. These data suggest that split-dose PEG preparation regimen is still not sufficient for optimal bowel preparation in diabetic patients undergoing colonoscopy.

The use of low-volume polyethylene glycol containing ascorbic acid versus 2 L of polyethylene glycol plus bisacodyl as bowel preparation for colonoscopy

Objective. Low-volume polyethylene glycol (PEG) bowel preparations have been developed to improve compliance for colonoscopy. Our study aimed to compare the efficacy and tolerability of low-volume PEG containing ascorbic acid for colonoscopy against 2 L of PEG plus bisacodyl. Methods. We prospectively enrolled consecutive inpatients who had not undergone polypectomy at the index colonoscopy and were subsequently referred for polypectomy at our hospital. A total of 62 patients were randomized to receive either low-volume PEG containing ascorbic acid (n = 31) or 2 L of PEG plus bisacodyl (n = 31) as a split-dose regimen in inpatients. The efficacy of preparation was determined using the Ottawa Bowel Preparation Score (OBPS) and a 4-point scale. Adverse events, tolerability, and willingness were evaluated using a questionnaire. Results. Based on the OBPS and 4-point scale, we determined that the efficacy of low-volume PEG containing ascorbic acid was comparable to that of the 2 L of PEG plus bisacodyl (p = 0.071 for OBPS, p = 0.056 for the 4-point scale). Adverse events were comparable between the two groups (p = 1.000). A greater proportion of patients in the low-volume PEG containing ascorbic acid (90.6%) and the 2L of PEG plus bisacodyl (96.9%) were willing to repeat the same preparation for subsequent colonoscopy.Conclusion. Low-volume PEG containing ascorbic acid had comparable efficacy and tolerability to 2 L of PEG plus bisacodyl, when given as a split dose, for colonoscopy in inpatients. Split-dose low-volume PEG containing ascorbic acid is a good alternative for bowel preparation for colonoscopy in inpatients.

638 Split-Dose Polyethylene Glycol (PEG) Versus Night-Before Single-Dose PEG for Hospitalized Patients Undergoing Colonoscopy. Outcomes From a Single-Center Quality Improvement Study

After intervention 1, rate of adequate prep was 81.5% (March/May 2014). No additional improvement was seen after intervention 2 (September/October 2014: 82.8%). Conclusions: Suboptimal bowel preparation has been shown to drastically increase the cost of colonoscopy. In this study, we have shown that a simple, strategically planned intervention utilizing clear patient instructions and nurse teaching in a high risk, vulnerable population was highly effective in improving bowel preparation in a short period of time. Further study is needed to determine whether an educational booklet with pictures will have an additional beneficial effect as compared to patient instructions alone.

3-L split-dose is superior to 2-L polyethylene glycol in bowel cleansing in Chinese population: a multicenter randomized, controlled trial.

Large volume (4 L) of polyethylene glycol (PEG) solution would ensure a better quality of bowel cleansing but might be poorly tolerated. Due to the smaller body size, lower body weight, and different diet habits, the large volume of 4-L PEG might be poorly tolerated by the Chinese population. In view of this, a balance should be made between the volume and effectiveness. This study aimed to compare the effectiveness, compliance, and safety between 3-L split-dose and 2-L PEG in Chinese population.Consecutive patients scheduled for colonoscopy were recruited from 5 tertiary medical centers in South China between April and July, 2014. Patients were prospectively randomized into 2 groups: 3-L split-dose PEG (3L-group) and 2 L PEG (2L-group). The primary endpoint was bowel cleansing and was defined according to Ottawa Bowel Preparation Scale (OBPS). The safety and compliance were also evaluated.A total of 318 patients were included in the analysis. The mean total OBPS score was significantly higher in 2L-group than in 3L-group (4.4 ± 2.7 vs 2.9 ± 2.4, P < 0.001). Both the intention-to-treat and per-protocol analysis found that rates of successful and excellent bowel preparation were much higher in 3L-group (89.9% and 78.0%) than 2L-group (79.2% and 48.4%), respectively (P < 0.001). The average cecum intubation time was significantly shorter in 3L-group (8.2 ± 3.7 min) than in 2L-group (10.3 ± 4.2 min) (P = 0.04). Adenoma detection rate in right colon was slightly higher in 3L-group than in 2L-group (17.6% vs 12.6%, P = 0.21). The safety and compliance including the taste, smell, and dosage of PEG were similar between 2 groups (P > 0.05).3-L split-dose PEG is superior to 2-L PEG by better bowel cleansing, improved safety and compliance, shorter cecum intubation time, and potentially higher adenoma detection rate in rightward colon in Chinese population.

Cost-Analysis Model of Colonoscopy Preparation Using Split-Dose Reduced-Volume Oral Sulfate Solution (OSS) and Polyethylene Glycol With Electrolytes Solution (PEG-ELS)

Cost-Analysis Model of Colonoscopy Preparation Using Split-Dose Reduced-Volume Oral Sulfate Solution (OSS) and Polyethylene Glycol With Electrolytes Solution (PEG-ELS)

Comparison of the Efficacy and Tolerability between Same-day Picosulfate and Split-dose Polyethylene Glycol Bowel Preparation for Afternoon Colonoscopy: A Prospective, Randomized, Investigator-blinded Trial.

Background/AimsIn the present study, we evaluated the efficacy and tolerability between same-day bowel preparation protocols using 2 sachets of Picosulfate and a 4 L split-dose polyethylene glycol (PEG) bowel preparation for afternoon colonoscopy.MethodsThe study had a single-center, prospective, randomized, and investigator-blinded, non-inferiority design. We evaluated bowel preparation quality according to the Ottawa scale, patient tolerability, compliance, incidence of adverse events, sleep quality, and polyp/adenoma detection rate.ResultsAmong the 196 patients analyzed (mean age, 55.3 years; 50.3% men), 97 received the same-day regimen of 2 sachets of picosulfate (group A) and 99 received the 4 L split-dose PEG regimen (group B). The Ottawa score of the total colon was 4.05±1.56 in group A and 3.80±1.55 in group B (P=0.255). The proportion of patients having adequate bowel preparation in the same-day picosulfate group (61.5%) was slightly less than the 4 L PEG group (71.3%); however, the difference was not statistically significant (P=0.133). Tolerability of the group A regimen was superior to that of the group B regimen (P<0.000). The same-day picosulfate regimen was associated with fewer adverse events, such as abdominal bloating (P=0.037) and better sleep quality (P<0.000).ConclusionsThe same-day picosulfate regimen and the 4 L split-dose PEG regimen had similar efficacy in bowel preparation for afternoon colonoscopy. However, the same-day picosulfate regimen was easier to administer, produced fewer adverse events, and enabled better sleep quality.

Split-dose Miralax® with Gatorade® for Bowel Preparation: A Meta-analysis of Randomized Controlled Trials

Purpose: Polyethylene glycol (PEG) is a very popular bowel preparation for colonoscopy. However, its large volume may reduce patient compliance, resulting in suboptimal preparation. Over the past few years, split-dosing has been shown to improve efficacy and tolerability of bowel preparation. Recently, a combination of MiraLAX® and Gatorade® has been studied in various randomized controlled trials (RCTs) as a lower volume and more palatable bowel preparation. However, results have varied. Therefore, we conducted a meta-analysis to assess the role of split-dose MiraLAX-Gatorade versus split-dose PEG for bowel preparation prior to colonoscopy. Methods: MEDLINE/PubMed, Embase, Cochrane databases, CINAHL, Scopus, and recent abstracts from major conference proceedings were searched (5/2013). RCTs on adults comparing split-dose MiraLAX-Gatorade (238-255 g in 64 ounces) versus split-dose PEG (4 L) for bowel preparation prior to colonoscopy were included. The effects were analyzed by calculating pooled estimates of quality of bowel preparation (satisfactory, unsatisfactory, excellent), patient tolerance (nausea, cramping, bloating), and polyp detection by using odds ratio (OR) with fixed and random effects models. Publication bias was assessed by funnel plots. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency. RevMan 5.1 was utilized for statistical analysis. Results: Four trials met inclusion criteria (N=698) with mean age ranging from 53.8-59.1 years. Splitdose MiraLAX-Gatorade demonstrated a statistically significant reduction in satisfactory (OR 0.43; 95% CI: 0.26-0.71, p<0.01) and excellent preparations (OR 0.34; 95% CI: 0.19-0.61, p<0.01) as compared to split-dose PEG. Furthermore, split-dose MiraLAX-Gatorade demonstrated a statistically significant increase in unsatisfactory preparations (OR 2.35; 95% CI: 1.41-3.90, p<0.01) as compared to split-dose PEG. No statistically significant differences were observed between the two groups for polyp detection (p=0.18), nausea (p=0.52), cramping (p=0.69), and bloating (p=0.71). No publication bias was noted. Conclusion: Split-dose MiraLAX-Gatorade for bowel preparation prior to colonoscopy was inferior to split-dose PEG in bowel preparation quality while demonstrating no significant improvements in adverse effects or polyp detection. Therefore, split-dose PEG appears superior to split-dose MiraLAX-Gatorade for bowel preparation prior to colonoscopy.

Death Knell for Placebo-Controlled Trials in Chronic Idiopathic Constipation?

Death Knell for Placebo-Controlled Trials in Chronic Idiopathic Constipation?

Low-Volume Morning-Only Polyethylene Glycol with Specially Designed Test Meals versus Standard-Volume Split-Dose Polyethylene Glycol with Standard Diet for Colonoscopy: A Prospective, Randomized Trial

Background/Aims: Split-dose polyethylene glycol (PEG) is a standard bowel preparation regimen for colonoscopy, but the large volume is burdensome to ingest and the night dose causes sleep disturbance. This study was performed to evaluate the efficacy and tolerability of a bowel preparation protocol using low-volume morning-only PEG with specially designed low-residue test meals (LV-PEG with TM) compared to a standard-volume split-dose PEG bowel preparation with a standard diet (SV-PEG with SD). Methods: This was a single-center, prospective, randomized, investigator-blinded, noninferiority study. The primary end point was bowel preparation quality according to the Ottawa scale. Tolerability, compliance, adverse events, sleep quality and polyp/adenoma detection were also assessed. Results: Among 197 patients analyzed (mean age 54.6 years, 51.3% men), 97 received LV-PEG with TM and 100 received SV-PEG with SD. The Ottawa score for the total colon was 3.76 ± 2.07 in the LV-PEG with TM group and 3.67 ± 1.57 in the SV-PEG with SD group (p = 0.723; difference 0.09, 95% confidence interval -0.60 to 0.42). The compliance was high (more than 95%) in both groups (p = 0.621). PEG was easier to ingest for patients in the LV-PEG with TM group compared to the SV-PEG with SD group [visual analogue scale (VAS) for difficulty: 4.64 ± 2.46 vs. 5.97 ± 2.42, respectively; p < 0.001]. Diet instructions were also easier to comply with for patients in the LV-PEG with TM group compared to the SV-PEG with SD group (VAS for difficulty: 3.11 ± 2.25 vs. 4.00 ± 2.39, respectively; p = 0.008). Patients in the LV-PEG with TM group had a lower incidence of abdominal bloating (p = 0.012) and better sleep quality (p < 0.001). There was no difference between the groups regarding polyp and adenoma detection. Conclusions: LV-PEG with TM and SV-PEG with SD have similar efficacy with regard to bowel preparation for colonoscopy. LV-PEG with TM provided easier PEG intake and diet compliance, less abdominal bloating and better sleep quality than SV-PEG with SD.

Tu1374 Low-Volume Morning-Only Polyethylene Glycol (PEG) With Specially Designed Test Meals vs. Standard-Volume Split-Dose PEG With Standard Diet for Colonoscopy: a Prospective, Randomized Trial

Split-dose PEG is a standard bowel preparation regimen for colonoscopy but large volume is burdensome to ingest and night dose makes sleep disturbance. This study was to evaluate the efficacy and tolerability of bowel preparation protocols using low volume morning-only PEG with specially designed low residue test meals (LV-PEG with TM) compared to standard volume split-dose PEG bowel preparation with standard diet instruction (SV-PEG with SD).

Esophagogastroduodenoscopy-assisted bowel preparation for colonoscopy

To compare the quality and tolerance of esophagogastroduodenoscopy (EGD)-assisted and conventional split-dose polyethylene glycol electrolyte solution for inpatient colonoscopy. The study was a randomized controlled trial in hospitalized patients. Hospitalized patients undergoing colonoscopy the day following EGD for evaluation of gastrointestinal (GI) bleeding or other symptoms. Patients randomized to either EGD-assisted bowel prep [2 L polyethylene glycol (PEG) administered endoscopically into distal duodenum at time of EGD, plus 1 L PEG orally the following day] or conventional-PEG (2 L PEG orally the evening prior and 1 L PEG orally the following day). The main outcome measurements are bowel preparation quality and patient tolerance of bowel prep. Forty-two patients randomized to EGD-assisted bowel prep and 40 patients to conventional-PEG. Overall mean ± SD preparation quality was superior for EGD-PEG (4.1 ± 2.8) vs conventional-PEG (6.5 ± 3.1; P = 0.0005). Seventy-four percent of patients rated EGD-PEG as easy or slightly difficult to tolerate compared to 46% for standard-PEG (P = 0.0133). Mean EGD-procedural time was greater for EGD-assisted subject (24 ± 10 min) compared to conventional-PEG prep subjects (15 ± 7 min; P < 0.0001). Conscious sedation requirements did not differ between groups. There were no significant prep-related adverse events in either group. In selected hospitalized patients, compared to a conventional split-dose regimen, use of EGD to administer the majority of PEG solution improves patient tolerance and quality of bowel preparation for colonoscopy.

Optimizing colonoscopy preparation

The focus of this review is to review recent literature on colonoscopy preparation, in order to determine what regime currently results in the highest rates of adequate bowel cleansing, in terms of the substance used, its dosing, timing and the role of dietary restrictions during preparation. Recent data have emphasized that poor bowel preparation is frequent and results in significant healthcare costs and risks to patients in terms of missed neoplasia, which may be particularly important in the proximal colon. Polyethylene glycol (PEG) preparation is superior to, and safer, than sodium phosphate preparation, and results are further improved by split-dose regimes. Regular diet until dinner, the day before colonoscopy does not impair preparation in the context of split-dose PEG regimes. Available data indicate that the optimal colonoscopy preparation regime is the split-dose PEG regime with regular diet until dinner. Strategies for patients with difficulties in achieving adequate bowel cleansing with standard regimes remains a difficulty. The role of adjuncts, such as bisacodyl, is also less defined.