Effect of Bowel Preparation Volume in Inpatient Colonoscopy. Results of a Prospective, Randomized, Comparative Pilot Study

Abstract

Background: Inpatient status has been shown to be a predictor of poor bowel preparation for colonoscopy; however, the optimal bowel preparation regimen for hospitalized patients is unknown. Our aim was to compare the efficacy of bowel preparation volume size in hospitalized patients undergoing inpatient colonoscopy.Methods: This prospective, single blinded (endoscopist), randomized controlled trial was conducted as a pilot study at a tertiary referral medical center. Hospitalized patients undergoing inpatient colonoscopy were assigned randomly to receive a high, medium, or low-volume preparation. Data collection included colon preparation quality, based on the Boston Bowel Preparation Scale, and a questionnaire given to all subjects evaluating the ability to completely finish bowel preparation and adverse effects (unpleasant taste, nausea, and vomiting). Results: Twenty-five colonoscopies were performed in 25 subjects. Patients who received low-volume preparation averaged a higher mean total BBPS (7.4, SD 1.62), in comparison to patients who received high-volume (7.0, SD 1.41) and medium-volume prep (6.9, SD 1.55), P = 0.77. When evaluating taste a higher score meant worse taste. The low-volume group scored unpleasant taste as 0.6 (0.74), while the high-volume group gave unpleasant taste a score of 2.2 (0.97) and the medium-volume group gave a score of 2.1 (1.36), P < 0.01.Conclusion: In this pilot study we found that low-volume colon preparation may be preferred in the inpatient setting due its better rate of tolerability and comparable bowel cleanliness when compared to larger volume preparation, although we cannot overreach any definitive conclusion. Further more robust studies are required to confirm these findings.Trial registration: clinicaltrials.gov NCT01978509

Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline

“…Rapid administration of the 1 L PEG solution has also been shown to be successful in case reports of patients with hematochezia requiring colonoscopy (150,151). In a pilot RCT of 25 patients randomized to a low-volume regimen (300 mL containing sodium sulfate, potassium sulfate, and magnesium sulfate), medium-volume regimen (2 L of PEG), or large-volume regimen (4 L of PEG), patients receiving a low-volume regimen had a slightly higher total Boston Bowel Preparation Scale compared with those receiving the high-volume regimen (7.4 vs 7.0), although the results were nonsignificant (152). Moreover, the low-volume group had excellent tolerability of the preparation, with a decreased perception of unpleasant taste of the preparation.…”