Effective bowel cleansing before colonoscopy: a randomized study of split-dosage versus non-split dosage regimens of high-volume versus low-volume polyethylene glycol solutions - 24/08/11
Reprint requests: Riccardo Marmo, MD, Division of Gastroenterology, Hospital “L. Curto,” Polla, Via Sottobraida 32, 84037 Sant' Arsenio, ItalyRiassunto |
Background |
Adequate bowel cleansing is essential for a high-quality, effective, and safe colonoscopy.
Objectives |
To evaluate the degree of colon cleansing comparing split-dosage versus non-split-dosage intake of two different polyethylene glycol (PEG) volumes (low-volume PEG + ascorbic acid vs standard-volume PEG-electrolyte solution) and to identify predictors of poor bowel cleansing.
Design |
Single-blind, active control, randomized study.
Setting |
Tertiary-care institutions in Italy.
Patients |
This study involved adult patients undergoing elective colonoscopy.
Intervention |
Colonoscopy with different bowel preparation methods.
Main Outcome Measurements |
Degree of bowel cleansing.
Results |
We randomized 895 patients, and 868 patients were finally included in intention-to-treat (ITT) analysis. Overall compliance was excellent (97%) for both preparation methods. No difference in tolerability was recorded. Palatability was superior with low volume compared with high volume (acceptable or good 58% vs 51%, respectively, P < .005), independently of intake schedule. PEG plus ascorbic acid produced the same degree of cleansing as standard-volume PEG-electrolyte solution (77% vs 73.4%, respectively, within the split-dosage group and 41.7% vs 44.3%, respectively, within the non-split-dosage group). Independently of PEG volumes, the split-dosage regimen produced markedly superior cleansing results over the same-day method (good/excellent 327/435, 75.2% vs 186/433, 43.0%, P = .00001). Maximum cleansing was observed in colonoscopies performed within 8 hours from the last fluid intake versus over 8 hours from the last fluid intake (P < .001). The degree of bowel cleansing affected both cecal intubation (failed intubation 11.7% with fair/poor preparation vs 1.2% with good/excellent preparation, P = .00001) and polyp detection rates (12.2% with fair/poor vs 24.6% with good/excellent preparation, P = .001). Aborted procedures were significantly more frequent in the non-split-dosage arm (21.2% vs 6.9%, odds ratio [OR] 3.60 [2.29-5.77], P < .0001). Independent predictors of poor bowel cleansing were male sex (OR 1.45 [1.08-1.96], P = .014) and a non-split-dosage bowel preparation schedule (OR 2.08 [1.89-2.37], P = .0001).
Conclusion |
Low-volume PEG plus ascorbic acid is as effective as high-volume PEG-electrolyte solution but has superior palatability. A split-dosage schedule is the most effective bowel cleansing method. Colonoscopy should be performed within 8 hours of the last fluid intake.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : ITT, PEG
Mappa
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| See CME section; p. 392 |
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| If you would like to chat with an author of this article, you may contact Dr Marmo at ricmarmo1@virgilio.it. |
Vol 72 - N° 2
P. 313-320 - agosto 2010 Ritorno al numero
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