Effectiveness and Tolerability of Very-low Volume Preparation for Colonoscopy: A Narrative Review

Abstract

Abstract:: An adequate bowel preparation is essential for a successful colonoscopy, in particular in the setting of colorectal cancer screening. However, up to one-quarter of colonoscopies are associated with inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, prolonged procedural time, and an increased likelihood of repeat the procedure. The ideal intestinal preparation should provide an optimal observation of the mucosa (at least> 90% of the visible surface), with adequate acceptability and safety for the patient. With this premise, a very low-volume 1 L PEG-ASC solution (Plenvu; Norgine, Harefield, United Kingdom) has been recently introduced to improve patients’ experience in colonoscopy by reducing the total intake of liquids to be consumed. This could represent a valid option for bowel cleansing, looking at CRC screening and surveillance programs, improving both the quality of the examination and the patients’ compliance. Nevertheless, it must be emphasized that a "one size fits all" preparation strategy is not feasible and that bowel preparation regime must always be selected and tailored by the clinician for each patient, evaluating the best options on a case by case basis. This narrative review aims to sum up the evidence regarding new bowel preparation regimens in order to help clinicians to tailor the best choice for patients undergoing colonoscopy.

The unmet needs for identifying the ideal bowel preparation

“…BP procedures also have some shortcomings. 78 These include the complexity of solution preparation, large volume, unpleasant taste, long duration of drinking (possibly >1 h), cleansing quality, and splitting schedule. Moreover, adverse events can occur, with a very few being serious.…”