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

Abstract

Background The British Columbia Colon Screening Program (BCCSP) is a population-based colon cancer screening program. In December 2018, physicians in Vancouver, Canada agreed to switch from a low-volume split preparation to a high-volume polyethylene glycol preparation after a meta-analysis of studies suggested superiority of the higher volume preparation in achieving adequate bowel cleansing and improving adenoma detection rates. Aims To compare the quality of bowel preparation and neoplasia detection rates using a high-volume split preparation (HVSP) versus a low-volume split preparation (LVSP) in patients undergoing colonoscopy in the BCCSP. Methods A retrospective review of patients undergoing colonoscopy through the BCCSP at St. Paul’s Hospital from July 2017 to November 2018 and December 2018 to November 2019 was conducted. Inclusion criteria included age 50 to 74 and patients undergoing colonoscopy through the BCCSP. Variables collected included patient demographics and bowel preparation quality. Rates of bowel preparation and neoplasia detection were analyzed using chi-squared test. Results A total of 1453 colonoscopies were included, 877 in the LVSP group and 576 in the HVSP group. No statistically significant difference was noted between rates of inadequate bowel preparation (LVSP 3.6% versus HVSP 2.8%; P = 0.364). Greater rates of excellent (48.4% versus 40.1%; P = 0.002) and optimal (90.1% versus 86.5%; P = 0.041) bowel preparation were achieved with HVSP. The overall adenoma detection rate was similar between the two groups (LVSP 53.1% versus HVSP 54.0%; P = 0.074). LVSP demonstrated higher overall sessile serrated lesion detection rate (9.5% versus 5.6%; P = 0.007). Conclusions Compared to LVSP, HVSP was associated with an increase in excellent and optimal bowel preparations, but without an improvement in overall neoplasia detection.

Efficacy of different bowel preparation regimen volumes for colorectal cancer screening and compliance with European Society of Gastrointestinal Endoscopy performance measures

“…Studies have shown that adequate patient instructions and lower volumes of bowel preparation increase patient compliance and willingness to repeat endoscopy 10,11 . However, reports on the effectiveness of ultra‐low volume bowel preparations pertaining to actual performance measures have suggested that they are not as effective as high‐ and low volume bowel preparations regimens 12–14 …”

“… 10 , 11 However, reports on the effectiveness of ultra‐low volume bowel preparations pertaining to actual performance measures have suggested that they are not as effective as high‐ and low volume bowel preparations regimens. 12 , 13 , 14 …”

Effects on BBPS score with bowel preparation time and dosage

“…Studies have shown that compared with low-dose PEG, high-dose PEG has a higher success rate of bowel preparation and better bowel preparation conditions. [ 5 ] Investigators have also found that bowel preparation with 1L PEG is effective in patients with inflammatory bowel disease. [ 6 ] There are other reports suggesting that lower volumes of 1-L PEG might be associated with higher levels of bowel cleansing and higher BBPS scores in each segment compared with 2-L PEG.…”