Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Prospective single-blinded single-center randomized controlled trial of Prep Kit-C and Moviprep: Does underlying inflammatory bowel disease impact tolerability and efficacy?
Waled Mohsen, Astrid-Jane Williams, Gabrielle Wark, Alexandra Sechi, Jenn-Hian Koo, Wei Xuan, Milan Bassan, Watson Ng, Susan Connor
Waled Mohsen, Department of Digestive Diseases, Gold Coast University Hospital, Gold Coast, 4215, Queensland, Australia
Waled Mohsen, Astrid-Jane Williams, Gabrielle Wark, Alexandra Sechi, Jenn-Hian Koo, Milan Bassan, Watson Ng, Susan Connor, Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
Astrid-Jane Williams, Wei Xuan, Watson Ng, Susan Connor, South West Sydney Clinical School, University of New South Wales, Sydney 2170, New South Wales, Australia
Wei Xuan, Susan Connor, Ingham Institute Applied Medical Research, Sydney 2170, New South Wales, Australia
Author contributions: Mohsen W and Williams AJ collected data, compiled data, blinded endoscopist (fellow), recruited patients from clinic, organized spreadsheet, developed tables, liaised wrote the manuscript; Wark G collected data and developed the figures; Sechi A inflammatory bowel disease nurse consultant who assisted with education, recruitment of patients and answering patient concerns during the trial process; Koo JH blinded assisted with manuscript review, study design and statistical analysi; Xuan W is statistician from the Ingham institute who assisted with the statistical analysis; Bassan M assisted with the review of the manuscript; Ng W recruited patients, assisted with study design and assisted with review process and manuscript development; Connor S developed study design and end points for the study, applied for ethics approval, assisted with the development of the manuscript.
Institutional review board statement: Approval was obtained from the Institutional Human Ethics and Research Office (reference HREC/12/LPOOL/108).
Clinical trial registration statement: There was no clinical trial registration for this study.
Informed consent statement: Informed consent form was not required for this study as this was a prospective single blinded single centre study.
Conflict-of-interest statement: All of the authors have no conflict of interest to disclose. We did not receive commercial or government funding for this article.
Data sharing statement: All data included in this study is deidentified.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement of items, and the manuscript was prepared and revised according to the CONSORT 2010 statement of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Waled Mohsen, FRACP, Gastroenterologist, Department of Digestive Diseases, Gold Coast University Hospital, Gold Coast 4215, Queensland, Australia. wmoh6298@uni.sydney.edu.au
Received: November 1, 2020
Peer-review started: November 1, 2020
First decision: November 30, 2020
Revised: January 11, 2021
Accepted: March 7, 2021
Article in press: March 7, 2021
Published online: March 21, 2021
ARTICLE HIGHLIGHTS
Research background
Colonoscopy remains the gold standard for detection of colonic disease. An optimal evaluation depends on adequate bowel cleansing. Patients with inflammatory bowel disease (IBD), require frequent endoscopic assessment for both activity and dysplasia assessment. Two commonly used bowel preparations in Australia are Prep Kit-C (Pc) and Moviprep (Mp). Little is known about tolerability, efficacy and safety of split protocols of Mp and Pc in both IBD and non-IBD patients.
Research motivation
To determine which bowel preparation is tolerable and effective in both IBD and non-IBD patients. Efficacy and tolerability are related, and both contribute to effectiveness. By maximizing effectiveness we minimise the chances of inadequate bowel cleansing and incomplete colonoscopy. This ensures that hospital and patient resources are not wasted.
Research objectives
This study’s primary aim was to compare tolerability, efficacy and safety of split protocols of Mp with Pc in participants having a colonoscopy. The secondary aim was to compare the efficacy and tolerability of either preparation in participants with or without IBD.
Research methods
Patients were randomized to Pc or Mp bowel preparation. Patients completed a questionnaire to assess tolerability. Efficacy was assessed using the Ottawa Bowel Preparation Score. Serum electrolytes and renal function were collected one week prior to colonoscopy and on the day of colonoscopy.
Research results
Of 338 patients met the inclusion criteria. Of 168 patients randomized to Mp and 170 to Pc. The efficacy of bowel preparation (mean Ottawa Bowel Preparation Score) was similar between Mp and Pc. Mean tolerability scores were similar in Mp and Pc. The mean tolerability score in the IBD group was lower than the non-IBD group. IBD patients described more abdominal pain with Mp when compared with Pc. Serum magnesium level increased with Pc compared with Mp in all patients.
Research conclusions
In this study, the efficacy, tolerability and safety of Mp and Pc were similar in all patients. However, patients with IBD reported lower tolerability with both preparations. Specifically, IBD patients had more abdominal pain with Mp.
Research perspectives
These results should be considered when recommending bowel preparation especially to IBD patients. More prospective studies are required in this field.
