A low-volume polyethylene glycol solution was associated with an increased suboptimal bowel preparation rate but had similar recommendations for an early repeat colonoscopy, procedure times, and adenoma detection rates

Abstract

Background/AimsLow-volume polyethylene glycol (PEG) bowel preparations are better tolerated by patients than high-volume preparations and may achieve similar preparation quality. However, there is little data comparing their effects on a recommendation for an early repeat colonoscopy (because of a suboptimal preparation), procedure times, adenoma detection rate (ADR), and advanced adenoma detection rate (AADR).MethodsThis is a retrospective cohort study of outpatient colonoscopies performed during a one-year period at a single academic medical center in which low-volume MoviPrep® (n = 1841) or high-volume Colyte® (n = 1337) was used. All preparations were split-dosed. Appropriate covariates were included in regression models assessing suboptimal preparation quality (fair, poor, or inadequate), procedure times, recommendation for an early repeat colonoscopy, ADR, and AADR.ResultsMoviPrep® was associated with an increase in having a suboptimal bowel preparation (OR 1.36; 95% CI: 1.06–1.76), but it was not associated with differences in insertion (p = 0.43), withdrawal (p = 0.22), or total procedure times (p = 0.10). The adjusted percentage with a suboptimal preparation was 11.7% for patients using MoviPrep® and 8.8% for patients using Colyte®. MoviPrep® was not associated with a significant difference in overall ADR (OR 0.93; 95% CI: 0.78–1.11), AADR (OR 1.18; 95% CI: 0.87–1.62), or recommendation for early repeat colonoscopy (OR 1.16; 95% CI: 0.72–1.88).ConclusionsMoviPrep® was associated with a small absolute increase in having a suboptimal preparation, but did not affect recommendations for an early repeat colonoscopy, procedure times, or adenoma detection rates. Mechanisms to reduce financial barriers limiting low-volume preparations should be considered because of their favorable tolerability profile.

Comparing the Real-World Effectiveness of High- Versus Low-Volume Split Colonoscopy Preparations: An Experience Through the British Columbia Colon Cancer Screening Program

“…However, it did increase the rate of excellent bowel preparations and reduced the rate of suboptimal preparations defined as fair, poor or incomplete. Two observational studies also support our finding and noted LVSP in association with increased suboptimal preparations ( 19 , 20 ). This appears to favour the HVSP over the LVSP in patients who are more likely to have suboptimal bowel preparation, such as those who are male, elderly, have elevated body mass index, use opioids or tricyclic antidepressants or have a history of diabetes, constipation and/or cirrhosis ( 12 , 19 , 21 , 22 ).…”

“…Finally, we did not have other patient characteristics such as medications, co-morbid medical illnesses, lifestyle factors and indication for colonoscopy that can affect adequacy of bowel preparation and prevalence of colon neoplasia. The main strength of our study lies in its generalizability and that our data reproduced findings in other studies comparing HVSP and LVSP ( 19 , 20 ). All provinces and the Yukon territory have implemented or announced colon screening programs which will lead to similar large cohorts undergoing colonoscopy to follow-up a positive FIT.…”