Total Boston Bowel Preparation Scale Score Research Articles

Effect of Glucagon-Like Peptide-1 Receptor Agonists on Bowel Preparation for Colonoscopy.

Inadequate bowel preparation can result in decreased diagnostic accuracy and therapeutic safety of colonoscopy for colon cancer screening. The Boston Bowel Preparation Scale (BBPS) has been used to assess the quality of bowel preparation. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are commonly used medications for diabetes mellitus and obesity that are known to delay gastrointestinal motility. We hypothesized that the use of GLP-1RA would be associated with decreased quality of bowel preparation. We performed a retrospective cohort study of patients who underwent screening or surveillance colonoscopy at a large academic medical center between December 2021 and December 2022. We included patients taking any GLP-1RA for diabetes or obesity during colonoscopy defined as our cases, and patients who were prescribed GLP-1RA at one point but not within 3 months of colonoscopy defined as our controls. We excluded patients on any promotility or antimotility agents and those without BBPS recorded on their procedure report. Independent t test assessed statistical differences in the case and control groups to compare the quality of bowel preparation for continuous variables, and the χ 2 test was used for categorical variables. Multivariate linear regression including diabetes as a covariate was also performed for continuous variables, and multivariate logistic regression was performed for categorical variables. A total of 446 patients were included in the study, comprising 265 (59%) cases and 181 controls (41%). There were no statistically significant differences between groups at baseline except for the diagnosis of diabetes ( P = 0.001) with a higher proportion of patients with diabetes in the cases. The mean BBPS was significantly higher in controls (7.0 ± 1.9 vs 7.5 ± 2.4, P = 0.046) when controlling for diabetes. The percentage of patients with a total BBPS score of <5 was significantly higher in cases (15.5% vs 6.6%, P = 0.01). The proportion of patients who required a repeat colonoscopy due to poor bowel preparation was also significantly higher in cases (18.9% vs 11.1%, P = 0.041). The use of GLP-1RA was associated with a statistically significantly lower quality of bowel preparation, with additional clinical significance given a notable difference in the need for a repeat colonoscopy. It will be essential to understand the cumulative effect of medications that may delay gastric emptying on the quality of bowel preparation to better understand the appropriate measures and counseling that need to be taken before undergoing outpatient colonoscopies.

Bowel preparation using 2-L split-dose polyethylene glycol regimen plus lubiprostone versus 4-L split-dose polyethylene glycol regimen: a randomized controlled trial

BackgroundColonoscopy is a standard procedure for evaluating colon diseases and screening for colorectal cancer, and bowel cleanliness prior to colonoscopy is key. The aim of this study was to compare the bowel cleansing efficacy of low-volume (2 L) split-dose polyethylene glycol (PEG) plus single-dose (24 µg) lubiprostone (LB) and high-volume (4 L) split-dose PEG.MethodsPatients scheduled to undergo outpatient colonoscopy between December 2019 and June 2021 at Rajavithi Hospital were enrolled and randomized into two groups: 2 L PEG + LB or 4 L PEG. Colon cleanliness was evaluated using the Boston Bowel Preparation Scale (BBPS) by reviewing images of the colon after completion of colonoscopy. Secondary outcomes comprised cecal intubation rate, procedure time, withdrawal time, polyp detection rate, adenoma detection rate, patient satisfaction, compliance (based on complete ingestion of bowel preparation regimen), willingness to repeat the preparation regimen, and associated adverse events.ResultsOne hundred and forty patients were included, with 70 in each group. The mean total and segment-specific BBPS scores were not significantly different between groups. However, the rate of adequate bowel preparation was significantly higher in the 2 L PEG + LB group than the 4 L PEG group (100% [95% CI 94.6–100] versus 88.4% [95% CI 78.4–94.9], p = 0.004) in the per-protocol analysis. Colonic polyps were the most common finding. The polyp detection rate, adenoma detection rate, and all secondary outcomes were statistically similar in the two groups (p > 0.05).ConclusionsThe combination of 2 L split-dose PEG plus LB improves bowel cleanliness (based on BBPS scores) to a comparable degree to the standard 4 L split-dose PEG, without additional adverse events and with a lower PEG volume.

Comparison of Two Types of 1-L Polyethylene Glycol-ascorbic Acid as Colonoscopic Bowel Preparation: A Prospective Randomized Study

Recently, 1-L polyethylene glycol-ascorbic acid (PEG-Asc) has been used to reduce the volume of preparation agents in colonoscopy. This clinical trial aimed to compare the efficacy and safety of two types of 1-L PEG-Asc (CleanViewAL® [Tae Joon Pharmaceutical Company, Seoul, Korea] and Plenvu® [Norgine, Harefield, United Kingdom]) in average-aged adults. This study was a prospective, randomized, non-inferiority, open-label, phase 4 clinical trial. The primary endpoint was the efficacy evaluated using the Boston bowel preparation scale (BBPS), and the secondary endpoint was clinical safety. In total, 173 patients were assigned to either the CleanViewAL® (n=84) or Plenvu® (n=89) group. Overall cleansing successes of 97.6% (82/84) and 98.8% (88/89) were achieved in the CleanViewAL® group and in the Plenvu® group, respectively, showing that CleanViewAL® has similar bowel cleansing efficacy to Plenvu® (95% CI, -0.052 to 0.027; p=0.207). The total BBPS score was 8.67±1.00 and 8.70±0.76 in the CleanViewAL® group and Plenvu® group, respectively (p=0.869). The most common adverse symptom was nausea, and no adverse symptoms requiring hospitalization were reported in either group. There were no cases of critical hypernatremia and liver dysfunction exceeding the common terminology criteria for adverse events grade I. An overall satisfaction score (scale of 1 to 10) showed no difference between the two groups (p=0.289). However, the CleanViewAL® group showed a higher taste satisfaction score (scale of 1 to 5) than the Plenvu® group (CleanViewAL®: 2.90±0.91, Plenvu®: 2.60±0.86, p=0.028). Both types of 1-L PEG-Asc, CleanViewAL® and Plenvu®, are effective and safe bowel cleansing agents in average-aged adults. CleanViewAL® was preferred in terms of taste satisfaction.

Real-word evaluation of differences in bowel preparation for colonoscopy between the digestive and the non-digestive physicians: A retrospective study

IntroductionUsing real-world data, we compared the quality of bowel preparation instructed by the digestive and non-digestive physicians in outpatients for colonoscopy and identified potential risk factors.MethodsThis was a retrospective study based on real-world data, which were collected from the Ningbo First Hospital in China from December 2019 to October 2020. Outpatients included were classified into the digestive and the non-digestive physician groups according to the referring physician. The primary outcome was adequate bowel preparation measured by the Boston Bowel Preparation Scale (BBPS), namely, a BBPS score of 2 or higher in any colonic segment and a total score ≥ 6. Secondary outcomes included the total mean BBPS scores and possible risk factors associated with poor bowel preparation.ResultsThere were 671 outpatients included, with 392 in the digestive physician group and 279 in the non-digestive physician group. Adequate bowel preparation was 84.2% in the digestive physician group and 71.0% in the non-digestive physician group (odds ratio [OR]: 1.50, p &amp;lt; 0.001), and the latter had lower total mean BBPS scores (6.12 ± 1.33 vs. 6.66 ± 1.29, p &amp;lt; 0.001). The non-digestive physician was an independent risk factor according to the multivariate logistic regression analysis (OR: 0.45, p &amp;lt; 0.001).ConclusionThe quality of bowel preparations instructed by non-digestive physicians was inferior to digestive physicians, which was a factor potentially associated with poor bowel preparation (ClinicalTrials.gov number: NCT04738578).

The Effectiveness and Tolerability of a Very Low-Volume Bowel Preparation for Colonoscopy Compared to Low and High-Volume Polyethylene Glycol-Solutions in the Real-Life Setting.

Adequate bowel cleansing is essential for high-quality colonoscopy. Recently, a new very low-volume 1 litre (1L) polyethylene glycol (PEG) plus ascorbate solution (ASC) has been introduced. Our aims were to assess the effectiveness and tolerability of this product compared to low-volume 2L PEG-ASC and high-volume 4L PEG solutions, in a real-life setting. In six endoscopy units in Sweden, outpatients undergoing colonoscopy were either prescribed solutions according to local routines, or the very low-volume solution in split dose regimen. Bowel cleansing effectiveness and patient experience was assessed using the Boston Bowel preparation scale (BBPS) and a patient questionnaire. A total of 1098 patients (mean age 58 years, 52% women) were included. All subsegment and the total BBPS scores were significantly greater for 1L PEG-ASC in comparison to other solutions (p < 0.05 for 1L PEG-ASC and 4L PEG for transverse and left colon, otherwise p < 0.001). Nausea was more frequent with 1L PEG-ASC compared to 2L PEG-ASC (p < 0.001) and vomiting were more often reported compared to both other solutions (p < 0.01 and p < 0.05 for 2L PEG-ASC and 4L PEG, respectively). Smell, taste, and total experience was better for 1L PEG-ASC compared to 4L PEG (p < 0.001), and similar compared to the 2L PEG-ASC. In conclusion, 1L PEG-ASC leads to better bowel cleansing compared to 2L PEG-ASC or 4L PEG products, with similar or greater patient satisfaction.

Effect of oral simethicone on the quality of colonoscopy: A systematic review and meta-analysis of randomized controlled trials.

In this systematic review and meta-analysis, we aimed to investigate the effect of oral simethicone (SIM), an antifoaming agent, on the quality of colonoscopy in terms of bowel preparation quality, adenoma or polyp detection rate (ADR/PDR) and cecal intubation rate (CIR). All randomized controlled trials (RCTs) on the use of SIM during bowel preparation for colonoscopy published up to 17 March 2021 were identified from the PubMed, EMBASE and Cochrane Library databases. Bowel preparation quality, ADR/PDR/CIR, cecal intubation time (CIT), withdrawal time (WT), patients' tolerability, acceptability and volume of foam and bubbles were compared between the SIM and non-SIM groups. Thirty-eight RCTs with 10 505 patients were included. Oral SIM significantly increased the rate of total Boston bowel preparation scale (BBPS) score ≥6 (risk ratio [RR]1.13, P < 0.0001), acceptability (RR1.15, P=0.01) and the rate of no or minimal foam and bubbles (RR1.28, P < 0.00001) and decreased abdominal distension (RR0.64, P < 0.0001). However, it had no significant impact on overall ADR, overall PDR, CIR, CIT or WT. The rate of total BBPS score ≥6 remained significantly higher in the SIM group when a single-dose laxative regimen or a SIM dosage of ≥320 mg was employed; and ADR, PDR and CIR were significantly increased in the SIM group among colonoscopy clinicians who achieved an ADR <31%, PDR <45% and CIR <96%, respectively. Oral SIM can improve bowel preparation quality, especially in patients receiving a SIM dosage of ≥320 mg or a single-dose laxative regimen. SIM may be preferred by junior colonoscopy physicians/trainees with a lower ADR/PDR or CIR.

Effects of a Personalized Smartphone App on Bowel Preparation Quality: Randomized Controlled Trial.

BackgroundAdequate bowel preparation is essential for the visualization of the colonic mucosa during colonoscopy. However, the rate of inadequate bowel preparation is still high, ranging from 18% to 35%; this may lead to a higher risk of missing clinically relevant lesions, procedural difficulties, prolonged procedural time, an increased number of interval colorectal carcinomas, and additional health care costs.ObjectiveThe aims of this study are to compare bowel preparation instructions provided via a personalized smartphone app (Prepit, Ferring B V) with regular written instructions for bowel preparation to improve bowel preparation quality and to evaluate patient satisfaction with the bowel preparation procedure.MethodsEligible patients scheduled for an outpatient colonoscopy were randomized to a smartphone app group or a control group. Both the groups received identical face-to-face education from a research physician, including instructions about the colonoscopy procedure, diet restrictions, and laxative intake. In addition, the control group received written information, whereas the smartphone app group was instructed to use the smartphone app instead of the written information for the actual steps of the bowel preparation schedule. All patients used bisacodyl and sodium picosulfate with magnesium citrate as laxatives. The quality of bowel preparation was scored using the Boston Bowel Preparation Scale (BBPS) by blinded endoscopists. Patient satisfaction was measured using the Patient Satisfaction Questionnaire-18.ResultsA total of 87 patients were included in the smartphone app group and 86 in the control group. The mean total BBPS score was significantly higher in the smartphone app group (mean 8.3, SD 0.9) than in the control group (mean 7.9, SD 1.2; P=.03). The right colon showed a significantly higher bowel preparation score in the smartphone app group (mean 2.7, SD 0.5 vs mean 2.5, SD 0.6; P=.04). No significant differences were observed in segment scores for the mean transverse colon (mean 2.8, SD 0.4 vs mean 2.8, SD 0.4; P=.34) and left colon (mean 2.8, SD 0.4 vs mean 2.6, SD 0.5; P=.07). General patient satisfaction was high for the smartphone app group (mean 4.4, SD 0.7) but showed no significant difference when compared with the control group (mean 4.3, SD 0.8; P=.32).ConclusionsOur personalized smartphone app significantly improved bowel preparation quality compared with regular written instructions for bowel preparation. In particular, in the right colon, the BBPS score improved, which is of clinical relevance because the right colon is considered more difficult to clean and the polyp detection rate in the right colon improves with improvement of bowel cleansing of the right colon. No further improvement in patient satisfaction was observed compared with patients receiving regular written instructions.Trial RegistrationClinicalTrials.gov NCT03677050; https://clinicaltrials.gov/ct2/show/NCT03677050

Impact of simethicone on bowel cleansing during colonoscopy in Chinese patients.

BACKGROUNDFour-liter polyethylene glycol (PEG) solutions are effective for bowel cleansing, but their large volume might hinder patient compliance. Due to the unique features of Asians, 4 L PEG might be a suboptimal bowel preparation in predominantly ethnically Asian countries. In view of this, a balance should be achieved between the volume and effectiveness. The ideal bowel cleansing regimen for a colonoscopy has yet to be determined in a Chinese population.AIMTo compare the cleansing efficacy of 3 L PEG plus simethicone with 4 L PEG.METHODSA total of 291 patients were randomly allocated to two groups: Group 1 (n = 145) received 4 L split-dose PEG (4-P); group 2 (n = 146) received 3 L split-dose PEG plus simethicone (3-PS). Bowel-cleansing efficacy was evaluated by endoscopists using the Boston bowel preparation scale (BBPS) and the bubbles score.RESULTSAlthough there were no significant differences in the total BBPS score or the adequate rate of bowel preparation between the two groups, the BBPS score of the right-side colon was significantly higher in the 3-SP group (2.37 ± 0.54 vs 2.21 ± 0.78; P = 0.04). Moreover, the use of simethicone significantly reduced bubbles in all colon segments (P < 0.001). The mean withdrawal time was significantly shorter in the 3-PS group (8.8 ± 3.4 vs 9.6 ± 2.3; P = 0.02). Furthermore, significantly more proximal adenomas were detected in the 3-PS group (53.6% vs 45.7%; P = 0.03). In addition, the proportions of patients with nausea and bloating were significantly lower in the 3-SP group (P < 0.01 for both). More patients in the 3-PS group expressed willingness to repeat the bowel preparation (87.7% vs 76.6%, P = 0.01).CONCLUSIONThree-liter PEG shows satisfactory bowel cleansing despite the decrease in dosage, and addition of simethicone with better bubble elimination and enhanced patient acceptance offers excellent potential impact on the detection of proximal adenomas in Chinese patients.

A134 A MULTI-CENTRE RANDOMIZED CONTROLLED TRIAL TO COMPARE TWO BOWEL CLEANSING REGIMENS AFTER A COLONOSCOPY WITH INADEQUATE BOWEL PREPARATION

Abstract Aims Failed bowel preparation is common during colonoscopy, yet the optimal purgative regimen to use for the next attempt is unknown. The objective of this study was to compare the efficacy, tolerability, and safety of two regimens at supratherapeutic doses for use after failed bowel preparation. Methods A multi-centre phase III endoscopist blinded randomized controlled trial (NCT02976805) was conducted in patients who failed bowel preparation, using the US Multi-Society Task Force (USMSTF) definition of inability to exclude polyps &amp;gt;5 mm in size and requiring a shortened interval to next colonoscopy. Regimen A consisted of 15 mg of bisacodyl and 2 + 2 L of split dose polyethylene glycol electrolyte solution (PEG) and Regimen B consisted of 15 mg of bisacodyl and 4 + 2 L of split dose PEG. The primary outcome was adequate bowel preparation, defined as a Boston Bowel Preparation Scale (BBPS) total score ≥ 6 with all segment scores ≥ 2. Secondary outcomes were adequate bowel preparation using the USMSTF definition, median BBPS, adenoma detection (ADR), advanced adenoma detection (aADR), sessile serrated polyp detection (SSPDR), and cecal intubation (CIR). Adverse events were assessed at the time of the colonoscopy and 14 days later. Results Between February 2017 and December 2019, 250 subjects were screened at four academic centres in Canada, of which 195 were randomized: 96 to Regimen A and 99 to Regimen B. The mean (SD) age was 60.6 (11.4) years, 87 (45.1%) were female, and the median (IQR) total BBPS score at previous failed colonoscopy was 3 (1,4). Regimen B was not superior to Regimen A in achieving adequate bowel preparation using the BBPS definition (87.6% vs. 91.1%, p=0.45) or the USMSTF definition (85.4% vs 91.1%, p=0.24), nor was it superior with respect to the median BBPS score (7 vs 7, p=0.50), mean ADR (31.5% vs 37.8%, p=0.37), aADR (11.2% vs 18.9%, p=0.15), SSPDR (5.6% vs 8.9%, p=0.40) or CIR (92.1% vs 96.7%, p=0.19). Regimen A had a higher adherence rate (88.2% vs. 74.7%, p=0.02) and greater willingness to undergo the bowel preparation again (91.2% vs. 66.2%, p&amp;lt;0.001). The only serious adverse event occurred in a patient randomized to Regimen B who was admitted to hospital for vomiting after colonoscopy. Conclusions Split dose 4L PEG with 15mg of bisacodyl is highly efficacious, well tolerated, and can be used for patients who previously failed first line bowel preparations. The additional 2L of PEG in Regimen B did not improve bowel preparation and was not as well tolerated. Funding Agencies AMOSO Opportunities Grant, Pharmascence Inc.

Telephonic Nurse Guidance for Colonoscopy: A Clinical Trial.

This study aims to analyze the effectiveness of nurse-conducted telephone guidance for bowel preparation before a colonoscopy after patients have received routine recommendations. A randomized, controlled, colonoscopist-blinded clinical trial was conducted at a Brazilian teaching hospital. Participants included patients aged ≥ 18, who were available via telephone (the intervention group was given guidance over telephone). Of the 109 total participants, 55 were placed into the intervention group (IG) and 54 into the control group (CG). Outcomes included Boston Bowel Preparation Scale (BBPS) scores, adenoma detection, and cecal intubation. Total BBPS scores showed a statistically significant reduction for the IG when compared to the CG (p < .001) (all colon segments were evaluated thus). Cecal intubation occurred in all exams for those in the IG (p = .027). No significant differences were found regarding adenoma detection. The examined educational intervention was an effective strategy for reeducating patients about bowel preparation.

Tu1093 EFFICACY OF MOSAPRIDE CITRATE WITH A SPLIT DOSE OF PEG PLUS ASCORBIC ACID FOR BOWEL PREPARATION IN ELDERLY PATIENTS: A RANDOMIZED CONTROLLED TRIAL

Old age is a risk factor of suboptimal bowel preparation. This study aimed to evaluate the efficacy of mosapride citrate with a split dose of polyethylene glycol (PEG) plus ascorbic acid for bowel preparation in elderly patients (≥65 years). This prospective investigator-blinded randomized study was conducted from November 2017 to October 2018. Patients were randomly divided into two groups: mosapride citrate with split-dose PEG plus ascorbic acid (mosapride group) or split-dose PEG plus ascorbic acid alone (non-mosapride group). Mosapride citrate 15 mg (Gastin CR®) was administered once with each split-dose of the bowel preparation. Bowel preparation quality was assessed using the Boston Bowel Preparation Scale (BBPS). A total of 257 patients were finally included and analyzed. Total BBPS score was significantly higher in the mosapride group than in the non-mosapride group (8.53 vs 8.24, P = 0.033). The BBPS scores of the right colon and mid-colon were 2.75 vs 2.61 (P = 0.044) and 2.89 vs 2.79 (P = 0.030), respectively. The rate of adequate preparation (BBPS ≥6) was similar in both groups (98.4% vs 98.5%, P = 0.968), while the rate of excellent preparation (BBPS = 9) was higher in the mosapride group than in the non-mosapride group (73.8% vs 61.1%, P = 0.029). The total incidence of adverse events during administration of the bowel cleansing agent, particularly abdominal fullness, was lower in the mosapride group (11.9% vs 30.5%, P < 0.001). Mosapride citrate with a split-dose of PEG plus ascorbic acid in elderly patients showed bowel preparation efficacy and reduced adverse events such as abdominal fullness during administration of the bowel cleansing agent.

Effect of an intensive patient educational programme on the quality of bowel preparation for colonoscopy: a single-blind randomised controlled trial

ObjectivePreprocedural bowel preparation is necessary for optimal colonoscopy visualisation. However, it is challenging to achieve high-quality bowel preparation among patients scheduled for colonoscopy. This study aims to evaluate the impact...

Efficacy of low-dose versus high-dose simethicone with polyethylene glycol for bowel preparation: A prospective randomized controlled trial.

Additional simethicone (SIM) can improve adequate bowel preparation and adenoma detection rate (ADR). However, there is no consensus on the optimal dose of SIM. In this study, we compared the adequate bowel preparation rate with supplementation of split-dose 2L polyethylene glycol (PEG) with low-dose SIM (200mg) versus high-dose SIM (1200mg). This was a prospective, randomized, observer-blinded trial involving consecutive subjects undergoing colonoscopy. The primary outcome was adequate bowel preparation as assessed by Boston Bowel Preparation Scale (BBPS) score. Four hundred subjects were randomly allocated to low-dose SIM or high-dose SIM group. Baseline characteristics were comparable in the two groups (P>0.05). No significant between-group differences were observed with respect to total bubble scale (BS) (8.49±1.00 vs 8.39±1.10, P=0.07), total BBPS score (8.70±0.81 vs 8.29±1.18, P=0.98), ADR (33.68% vs 31.79%, P=0.69) or withdrawal time (13 [range, 10-16] min vs 13 [10-15] min, P=0.96). The intubation time in low-dose SIM group was significantly shorter than that in high-dose SIM group (8 (4-16) min vs 10 [6-17] min, P=0.04). In addition, BS scores as well as diminutive ADR in right colon were superior in the low-dose SIM group (2.68±0.59 vs 2.52±0.73, P=0.03 and 54.29% vs 30.30%, P=0.046, respectively). Addition of low-dose SIM to split-dose 2L PEG was as effective as addition of high-dose SIM with respect to adequate bowel preparation, ADR and patient tolerance. However, low-dose SIM was superior with respect to intubation time, right colon BS scores, right colon diminutive ADR and cost savings.

Efficacy of mosapride citrate with a split dose of polyethylene glycol plus ascorbic acid for bowel preparation in elderly patients: A randomized controlled trial.

Background/Aims:Old age is a risk factor of suboptimal bowel preparation. This study aimed to evaluate the efficacy of mosapride citrate with a split dose of polyethylene glycol (PEG) plus ascorbic acid for bowel preparation in elderly patients (aged ≥65 years) before they underwent a colonoscopy.Materials and methods:This prospective investigator-blinded randomized study was conducted from November 2017 to October 2018. The patients were randomly divided into 2 groups, a mosapride group (mosapride citrate with a split-dose of PEG plus ascorbic acid) or a non-mosapride group (a split-dose of PEG plus ascorbic acid alone). Mosapride citrate 15 mg (Gastin CR) was administered once with each split-dose of the bowel preparation. The bowel preparation quality was assessed using the Boston Bowel Preparation Scale (BBPS).Results:A total of 257 patients were finally included and analyzed in our study. The total BBPS score was significantly higher in the mosapride group than in the non-mosapride group (8.53 vs 8.24, P = .033). The BBPS scores of the right colon and mid-colon were 2.75 vs 2.61 (P = .044) and 2.89 vs 2.79 (P = .030), respectively. The rate of adequate bowel preparation (BBPS ≥ 6) was similar in both groups (98.4% vs 98.5%, P = .968), while the rate of excellent bowel preparation (BBPS = 9) was higher in the mosapride group than in the non-mosapride group (73.8% vs 61.1%, P = .029). The total incidence of adverse events during the administration of the bowel cleansing agent, particularly abdominal fullness, was lower in the mosapride group (11.9% vs 30.5%, P < .001).Conclusion:The administration of mosapride citrate with a split-dose of PEG plus ascorbic acid in elderly patients showed an increase in bowel preparation efficacy and reduced adverse events, particularly abdominal fullness, during the administration of a bowel cleansing agent.

Efficacy of single- versus split-dose polyethylene glycol electrolyte solution for morning colonoscopy: A randomized controlled study.

Background:Split-dose (SPD) regimen has been proved more effective than a single-dose (SID) regimen for various drug preparations; however, limited data have focused on morning colonoscopy. We implemented this study to compare the bowel cleanliness and tolerability of a same-day SID versus SPD 2 L polyethylene glycol electrolyte solution (PEG) for morning colonoscopy.Methods:Patients undergoing morning colonoscopy were randomized into two groups, SID or SPD. In the SID group, patients had to complete 2 L PEG between 4 and 6 am on the day of colonoscopy. In the SPD group, patients had to complete 1 L PEG between 8 and 9 pm on the day before followed by another 1 L PEG between 5 and 6 am on the day of colonoscopy. Colonoscopy was performed between 8 and 12 am under anesthesia. Investigators and endoscopists were blinded to the allocation. The primary end point was the effectiveness of bowel cleansing according to the Boston Bowel Preparation Scale (BBPS). The secondary outcomes were polyp detection rate, compliance, tolerability, and patient satisfaction.Results:Overall, there were 147 and 148 patients in the SID and SPD group, respectively. The SPD group had a better quality of bowel preparation than the SID group with a total BBPS score of 7.25 ± 1.53 versus 6.71 ± 1.65 (P = 0.005). No difference in the polyp detection rate was noted, although more polyps were detected in the SPD group. More patients felt acceptable with the bowel preparation regimen in the SPD group compared to the SID group (76% vs. 65%, P = 0.03). The adverse events were more commonly observed in the SID group, presented as nausea and vomiting.Conclusion:For morning colonoscopy, split-dose 2 L PEG is superior to single-dose 2 L PEG by improved bowel preparation, better tolerability, and patient satisfaction.

559 Patients' Descriptions of Their Last Bowel Movement Before Colonoscopy, Converted to a Standardized Score, Shows Strong Correlation With Their Boston Bowel Preparation Scale (BBPS) Score

INTRODUCTION: Colorectal cancer is the third most common cancer worldwide. Early detection of adenomatous polyps and adenocarcinoma reduces mortality. The effectiveness of colonoscopy for colorectal cancer screening is reliant on the quality of bowel preparation. Patients with inadequate bowel preparation may require repeat colonoscopy; this exposes patients to further risks while placing financial stress on individuals and healthcare systems. The purpose of this study is to assess if a patient's description of their last bowel movement, converted to a standardized score, correlates to the quality of bowel cleansing. METHODS: This is a cross-sectional study performed at two hospitals with data collected over two months. On the day of the colonoscopy, prior to the procedure, outpatients were asked by a resident physician to describe their last bowel movement. The description was converted to a standardized score: “fully solid”, assigned a score of 0; “liquid with solid pieces”, assigned a score of 1; “brown liquid”, assigned a score of 2; and “clear / yellow liquid”, assigned a score of 3. Subsequently, each patient's total and segmental Boston Bowel Preparation Scale (BBPS) score was determined and recorded by the clinician performing the colonoscopy. The nurses and clinicians performing the procedure were blinded to the patient's last bowel movement description. Data analysis using bivariate Pearson's Correlation was used to assess the strength of correlation between the patients' descriptions and BBPS scores. RESULTS: Study population characteristics: N = 121, 66 F and 55 M; mean age 56.16 with Std. Dev. of 16.12; mean total BBPS 7.74 with Std. Dev. of 1.87. Bivariate Pearson's Correlation showed a strong correlation (r = 0.738; P &lt; 0.001) between the patients' descriptions and total BBPS score. Patients' descriptions versus segmental BBPS scores showed: a strong correlation with Left Colon BBPS (r = 0.702; P &lt; 0.001); a moderate correlation with Transverse Colon BBPS (r = 0.632; P &lt; 0.001); and a moderate correlation with Right Colon BBPS (r = 0.667; P &lt; 0.001). CONCLUSION: A patient's description of their last bowel movement, converted to a standardized score, shows a strong correlation with their BBPS score. One implication of identifying a patient with inadequate bowel preparation before a colonoscopy is potentially rescheduling the procedure. Alternatively, it may be possible to provide patients with extra time and medication for colon cleansing before the colonoscopy is attempted.

The effect of quality of segmental bowel preparation on adenoma detection rate

BackgroundThe effectiveness in surveillance colonoscopy largely depends on the quality of bowel preparation. We aimed to investigate the quality of bowel preparation segmentally and its effect on Adenoma Detection Rate (ADR) and Advanced Adenoma Detection Rate (AADR) at corresponding bowel segments.MethodsThis is a single-centered and cross-sectional study. A consecutive of 5798 patients who underwent colonoscopy examination were included. Bowel preparation was evaluated based on Bowel Bubble Scale (BBS) in general and Boston Bowel Preparation Scale (BBPS) in each segment (right side, transverse and left side of colon) and total BBPS scores. The quality of bowel preparation was correlated with ADR and AADR.ResultsFour thousand nine hundred forty colonoscopies (14,820 bowel segments) were included in the final analysis. In which 30.9% scored 3, 57.5% scored 2, 11.2% scored 1 and 0.4% scored 0 on basis of BBPS. For each score, ADR were 10.8, 7.7, 4.9 and 3.2%, respectively; whereas AADR were 4.5, 2.8,1.8 and 1.6% (P < 0.05). 36.9% of the colonoscopies showed presence of minimal bubbles and 34.3% with no bubble. For bowels without bubbles and with a large amount of bubbles, ADR were 28.3 and 20.0% respectively; and AADR were 13.3 and 7.1% respectively.ConclusionsSegmental bowels’ cleanliness and the amount of bubbles in bowels significantly affect ADR and AADR. The better the bowel preparation at each segment is and the less bubbles in the bowel there are, the higher ADR and AADR we got. We suggest repeating colonoscopy if any segment of the bowel preparation is poor, or if there is more bubbles, even if the total score of BBPS indicates good or fair bowel preparation.

Clinical comparison of low-volume agents (oral sulfate solution and sodium picosulfate with magnesium citrate) for bowel preparation: the EASE study.

Background/AimsThis study compared the efficacy, compliance, and safety of bowel preparation between sodium picosulfate with magnesium citrate (SPMC) and oral sulfate solution (OSS).MethodsA prospective randomized multicenter study was performed. Split preparation methods were performed in both groups; the SPMC group, 2 sachets on the day before, and 1 sachet on the day of the procedure, the OSS group, half of the OSS with 1 L of water on both the day before and the day of the procedure. The adenoma detection rate (ADR), adequacy of bowel preparation using the Boston Bowel Preparation Scale (BBPS) score, patient satisfaction on a visual analog scale (VAS), and safety were compared between the 2 groups.ResultsThis study analyzed 229 patients (121 in the SPMC group and 108 in the OSS group). ADR showed no differences between 2 groups (51.7% vs. 41.7%, P>0.05). The mean total BBPS score (7.95 vs. 8.11, P>0.05) and adequate bowel preparation rate (94.9% vs. 96.3%, P>0.05) were similar between the 2 groups. The mean VAS score for taste (7.62 vs. 6.87, P=0.006) was significantly higher in the SPMC group than in the OSS group. There were no significant differences in any other safety variables between the 2 groups except nausea symptom (36.1% vs. 20.3%, P=0.008).ConclusionsBowel preparation for colonoscopy using low volume OSS and SPMC yielded similar ADRs and levels of efficacy. SPMC had higher levels of satisfaction for taste and feeling than did OSS.

Clinical effect of oral olive oil combined with polyethylene glycol electrolyte on bowel preparation for chronic constipation patients

Objective To investigate the effectiveness and safety of oral olive oil combined with polyethylene glycol electrolyte (PEG) on bowel preparation before colonoscopy for chronic constipation patients. Methods A randomized, single-blind, prospective study was conducted on 180 patients with chronic constipation, who underwent colonoscopy at Tangdu Hospital of the Fourth Military Medical University from November 2017 to May 2018. Patients were randomly divided into three groups. Patients in group A took 60 mL olive oil and a piece of crystal sugar at 7: 30 pm the day before colonoscopy, followed by 1 500 mL PEG at 8: 00 pm before the test, and 1 500 mL PEG at 5: 00 am the day of colonoscopy. Patients in group B took 60 mL olive oil and a piece of crystal sugar after administration of PEG at 8: 00 pm the day before colonoscopy, followed by 1 500 mL PEG at 5: 00 am the day of colonoscopy. The group C was given 1 500 mL PEG at 8: 00 pm the day before colonoscopy, and another 1 500 mL PEG at 5: 00 am the day of colonoscopy. We recorded the time of first defecation after taking medication, the number of defecation before sleep, the total number of defecation, the score of Boston bowel preparation scale (BBPS) of the right, middle and left colon, and the adverse reactions, and compared the data among the three groups. The measurement data was compared using the analysis of variance. After the difference was found, the LSD-t test was used to compare between the two groups. The enumeration data was compared using the Pearson χ2 test. Results One patient in the group B terminated colonoscopy due to unable to continue cooperation during the examination. Group B and C both excluded one patient because of a large mass found in the descending colon of patients. Finally, there were 60 cases in the group A, 58 in the group B, and 59 in the group C. There was no statistical difference between the three groups in the general resource (P>0.05). The time of first defecation after taking medication for the group A, B and C was (2.25±2.32) h, (2.43±2.39) h and (3.36±2.79) h respectively, with statistical difference (F=3.36, P=0.037). The time of first defecation was longer in the group C than that of the group A and B (P=0.016 and P=0.046, respectively). The number of defecation before sleep for the group A, B and C was 3.47±2.09, 3.24±1.76 and 2.49±1.58 respectively, with statistical difference (F=4.65, P=0.011). The number of defecation before sleep was lesser in the group C than that of the group A and B (P=0.004, P=0.027, respectively). The total number of defecation for the group A, B and C was 7.20±2.67, 6.81±2.31 and 5.64±2.22 respectively. The difference among the three groups was statistically significant (F=6.68, P=0.002). For the group A and B, the total number of defecation was both more than that of the group C (P=0.001, P=0.010). There were no statistical differences among the three groups in the BBPS score of the left and middle colon and the total BBPS score (all P>0.05). The BBPS score of the right colon for the group A, B and C was 2.03±0.82, 1.95±0.87 and 1.53±0.80 respectively, with statistical difference (F=6.38, P=0.002), and was lower in the group C than that of the group A and B (P=0.001, P=0.006, respectively). Adverse reactions after taking medication including nausea, vomiting, abdominal pain, and bloating were respectively reported in 7, 3, 0 and 3 cases in the group A, 5, 3, 0 and 6 in the group B, and 4, 2, 1 and 4 in the group C, and there was no statistical difference among the three groups (χ2=4.35, P=0.824). Conclusion Administration of olive oil compared with PEG can improve the cleanness of right colon for chronic constipation patients, shorten the time of first defecation after taking medication, and increase the number of defecation before sleep and the total number of defecation during bowel preparation. Taking olive oil before or after PEG at the night before colonoscopy has no significantly effect on bowel preparation and adverse reactions. Key words: Colonoscopy; Olive oil; Polyethylene glycol electrolyte; Chronic constipation; Bowel preparation

Clear Liquid Versus Low-fibre Diet in Bowel Cleansing for Colonoscopy in Children: A Randomized Trial.

In light of a paucity of data on the role of diet in colonoscopy preparation in paediatric population, the present study was designed to compare the effectiveness of clear liquid and low-fibre diets for breakfast and lunch on the day preceding colonoscopy in children. This prospective, randomised trial was conducted at the Department of Paediatric Gastroenterology and Nutrition in Warsaw, Poland. Eligible patients, referred for colonoscopies, were 6 to 18 years old. Patients were randomly divided into 2 groups: the first received a clear liquid diet and the second a low-fibre diet on the day before colonoscopy. In the afternoon, all participants were asked to drink polyethylene glycol with electrolytes at a dose of 66 mL/kg to a maximum of 4 L. The effectiveness of bowel cleansing was measured using the Boston Bowel Preparation Scale (BBPS). The preparation tolerance was assessed by parents and children using a visual analogue scale. Adverse effects were reported. In total, 184 patients were enrolled. Of those, 96 received the clear liquid diet and 88-the low-fibre diet. The mean age of both groups was 15 years. There were no differences between the 2 study groups in age, weight, and sex, as well as in total BBPS score (BBPS ≥ 5 96.6% vs 95.1%, P = 0.5). The frequency of adverse effects was similar in both groups; nausea was the most common (P = 0.8). Clear liquid and low-fibre diets administered to children the day before colonoscopy demonstrated similar bowel cleansing effectiveness.