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

Abstract

Background Colonoscopy 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. Methods Patients 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. Results One 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). Conclusions The 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.

Efficacy of Polyethylene Glycol Electrolyte Powder Combined With Linaclotide for Colon Cleansing in Patients With Chronic Constipation Undergoing Colonoscopy: A Multicenter, Single-Blinded, Randomized Controlled Trial

“…The BBPS is a valid and reliable instrument for rating the quality of bowel preparation during colonoscopy ( 15 ). One study showed that the PEG combined with lubiprostone (LB, 24 µg) could enhance the rate of adequate bowel preparation, rather than affecting the mean total and segment-specific BBPS scores ( 20 ). Conversely, another study showed that the PEG combined with mosapride could elevate the total BBPS score with better bowel preparation efficacy and lower adverse events, as opposed to affecting the rate of adequate bowel preparation (BBPS ≥6) ( 21 ).…”

Establishment of a risk prediction model for bowel preparation failure prior to colonoscopy

“…The endoscopist used the Boston Bowel Preparation Scale (BBPS) [ 15 ] to score the cleanliness of the three colonic segments of the patient’s right colon (including ileocecal and ascending colon), transverse colon (including hepatic flexure and splenic flexure), and left colon (including descending colon, sigmoid colon, and rectum). The scoring criteria were as follows: 0, a solid stool could not be removed from the intestinal cavity and the entire intestinal mucosa was not visible; 1, the intestinal cavity was still filled with stool or dark liquid, and part of the intestinal mucosa was visible; 2, a small amount of stool or dark liquid remained in the intestinal cavity and the intestinal mucosa was visible; 3, the intestinal cavity did not contain any stool or dark liquid and the entire intestinal mucosa was visible.…”