Published online Apr 28, 2020. doi: 10.3748/wjg.v26.i16.1950
Peer-review started: January 10, 2020
First decision: March 6, 2020
Revised: March 26, 2020
Accepted: April 21, 2020
Article in press: April 21, 2020
Published online: April 28, 2020
The effectiveness of colonoscopy strictly depends on adequate bowel cleansing. Recently, a 1 L polyethylene glycol plus ascorbate (PEG-ASC) solution has been introduced on the evidence of three phase-3 randomized controlled trials.
The 1 L PEG-ASC solution has never been tested in a real-life setting, where patients’ characteristics may differ from those of randomized controlled trials volunteers, and where the incidence of adverse events (AEs) may even be higher.
In this study, we aimed to assess the effectiveness and tolerability of the 1 L preparation compared to 4 L and 2 L-PEG solutions in a real-life setting.
Patients undergoing a screening or diagnostic colonoscopy after a 4, 2 or 1 L PEG preparation, were consecutively enrolled in 5 Italian centers. Bowel cleansing was assessed through the Boston Bowel Preparation Scale (BBPS). Adherence was defined as consumption of at least 75% of each dose, while tolerability was evaluated through a semi-quantitative scale. Safety was systematically monitored through AEs reporting.
Bowel cleansing by Boston Bowel Preparation Scale was 6.5 ± 1.5 overall and 6.3 ± 1.5, 6.2 ± 1.5, 7.3 ± 1.5 in the subgroups of 4 L, 2 L and 1 L-PEG preparation, respectively. Cleansing success was achieved in 72.4%, 74.1% and 90.1%, while a high-quality cleansing of the right colon in 15.9%, 12.0% and 41.4% for 4 L, 2 L and 1 L-PEG preparation groups, respectively. The 1 L preparation was the most tolerated compared to the 2 and 4 L-PEG solutions in the absence of serious AEs within any of the three groups. Multiple regression models confirmed 1 L PEG-ASC preparation as an independent predictor of overall cleansing success, high-quality cleansing of the right colon and of tolerability.
The effectiveness and tolerability of 1 L PEG-ASC show that it is an independent predictor of overall cleansing success, high-quality cleansing of the right colon and of tolerability
This very-low-volume solution will be useful to improve the quality and tolerability of bowel preparation increasing, and the adherence to colorectal cancer screening and surveillance programs.