Impact of high‐volume, intermediate‐volume and low‐volume bowel preparation on colonoscopy quality and patient satisfaction: An observational study

Waldmann, Elisabeth; Penz, Daniela; Majcher, B; Zagata, J; Šinkovec, Hana; Heinze, Georg; Dokladanska, A; Szymanska, A; Trauner, Michael; Ferlitsch, Arnulf; Ferlitsch, Monika

doi:10.1177/2050640618809842

Cited by 17 publications

(16 citation statements)

References 30 publications

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“…While the former was compared to high-volume PEG at least in terms of e cacy and tolerability (14), the latter has been compared only with other low-volume preparations (20)(21)(22). Moreover, real-life data are con icting: a recent prospective observational study has shown better cleansing results and higher ADR and AADR with 4L PEG compared to lower volume preparations (23).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Tolerability of High and Low-volume Bowel Preparation Compared: a Real-life Single-blinded Large-population Study

Occhipinti

Soriani

Bagolini

et al. 2020

Preprint

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Background: Low-volume (LV) preparations for colonoscopy have shown similar efficacy compared to high-volume (HV) ones in trials. However, real-life clinical outcomes data are lacking. Our aim was to assess patients’ free choice among HV preparations (4L polyethylene glycol, PEG) and LV (2L PEG plus bisacodyl) and to compare efficacy and tolerability. Methods: Consecutive outpatients referred for colonoscopy could choose either LV or HV preparation with schedules (day-before or split-dose) depending on their appointment time. Adequate bowel preparation according to Boston Bowel Preparation Scale, clinical outcomes and self-reported tolerability of HV and LV were blindly assessed.Results: 2,040 patients were enrolled and 1,815 (age 60.6 years, 50.2% men) finally included. LV was chosen by 52% of patients (50.8% of men, 54.9% of women). Split-dose schedule was more common with HV (44.7% vs. 38.2%, p=0.0055). HV and LV preparations showed similar adequate bowel preparation rates (89.2% vs. 86.6%, p=0.0983) but HV ones resulted higher in detection rates for polyps (PDR; OR 1.30, 95% CI 1.03–1.64, p=0.0254), adenomas (ADR; OR 1.28, 95% CI 0.99–1.65, p=0.0519) and advanced adenomas (AADR; OR 1.54, 95% CI 0.96–2.46, p= 0.0723) after adjustment for sex, age, indications. Visual Analogue Scale tolerability scored equally (7 [5-9]) but a ≥75% dose intake was more frequent with LV.Conclusions: in a real-life setting, LV preparation confirms similar efficacy and tolerability compared to HV. However, with higher PDR and a trend toward higher ADR and AADR, HV should still be considered the reference standard for clinical trials.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Tolerability of High and Low-volume Bowel Preparation Compared: a Real-life Single-blinded Large-population Study

Occhipinti

Soriani

Bagolini

et al. 2020

Preprint

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“…Our first example is a study comparing four different bowel purgatives (A, B, C, and D) and their effect on the quality of colonoscopy. The procedure was called a ‘success’ if the cecum was intubated by the endoscopist, or ‘failure’ otherwise (see [22] for more details). The data set used in a preliminary analysis consisted of 4132 patients and suffered from a separation issue as the cecum of patients that used purgative B, which was the smallest of the four groups, was always successfully intubated.…”

Section: Resultsmentioning

confidence: 99%

Bring More Data!—A Good Advice? Removing Separation in Logistic Regression by Increasing Sample Size

Šinkovec

Geroldinger

Heinze

2019

IJERPH

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The parameters of logistic regression models are usually obtained by the method of maximum likelihood (ML). However, in analyses of small data sets or data sets with unbalanced outcomes or exposures, ML parameter estimates may not exist. This situation has been termed ‘separation’ as the two outcome groups are separated by the values of a covariate or a linear combination of covariates. To overcome the problem of non-existing ML parameter estimates, applying Firth’s correction (FC) was proposed. In practice, however, a principal investigator might be advised to ‘bring more data’ in order to solve a separation issue. We illustrate the problem by means of examples from colorectal cancer screening and ornithology. It is unclear if such an increasing sample size (ISS) strategy that keeps sampling new observations until separation is removed improves estimation compared to applying FC to the original data set. We performed an extensive simulation study where the main focus was to estimate the cost-adjusted relative efficiency of ML combined with ISS compared to FC. FC yielded reasonably small root mean squared errors and proved to be the more efficient estimator. Given our findings, we propose not to adapt the sample size when separation is encountered but to use FC as the default method of analysis whenever the number of observations or outcome events is critically low.

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Section: Discussionmentioning

confidence: 99%

“…In a study of 5000 patients undergoing screening colonoscopy, ~ 20% of patients stated that bowel preparation was one of the most worrisome factors before the planned procedure [ 18 ]. The authors of that study concluded that optimizing the taste of bowel preparations and the required volume intake would likely increase participation rates for screening colonoscopy [ 18 ]. The current survey found that that most (84.7%) patients who reported previously taking a bowel preparation believed their experience with NER1006 was much better/better or about the same compared with that for the previously administered product.…”

Section: Discussionmentioning

confidence: 99%

Patient experience with NER1006 as a bowel preparation for colonoscopy: a prospective, multicenter US survey

Cash

Moncrief²,

Epstein

et al. 2021

BMC Gastroenterol

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Background NER1006 (Plenvu®, Salix Pharmaceuticals, Bridgewater, NJ) is a 1 L polyethylene glycol bowel preparation indicated for colonoscopy in adults. A US online survey assessed real-world ease of use and treatment satisfaction in individuals who received NER1006. Methods Adults were recruited from 444 US community gastrointestinal practices and provided a kit number for enrollment into an online survey to be completed within 2 weeks. Survey questions evaluated colonoscopy history and prior bowel preparation(s) prescribed, patient experience during NER1006 administration, and patient satisfaction with the bowel preparation process. A 9-point predefined grading scale was used to evaluate ease of NER1006 preparation and consumption (range, 1 “very difficult” to 9 “very easy”); the perceived importance of volume requirement and clear liquid options (range, 1 “not important at all” to 9 “very important”); and patient satisfaction (range, 1 “not satisfied at all” to 9 “very satisfied”). Results 1630 patients were enrolled, 1606 underwent colonoscopy, and 1598 completed the survey between September 15, 2018 and February 28, 2019. Among 1606 patients who had a colonoscopy, 62.5% were female, and the mean patient age was 54.4 years (range 18–89 years). Most patients (74.7%) did not report a family history of colon cancer, 62.6% had undergone prior colonoscopy, and 64.8% were undergoing colonoscopy for routine colorectal cancer screening. A majority (76.1%) of patients who completed the survey reported that NER1006 was very easy to prepare and take, and 89.9% were very or moderately satisfied with NER1006 overall. Most (97.6%) patients reported consuming all or most of the bowel preparation. Among 1005 patients with previous bowel preparation use, 84.7% indicated that their experience with NER1006 was much better or better (65.3%) or about the same (19.4%) compared with previously used bowel preparations, while only 15.3% rated NER1006 as worse or much worse. Conclusions In this first real-world, US multicenter survey, patient-reported experience with NER1006 as a bowel preparation for colonoscopy was favorable and adherence was high. The majority of patients were very or moderately satisfied with the overall experience and found it much better/better than previously used bowel preparations. Trial registration: Not applicable

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Impact of high‐volume, intermediate‐volume and low‐volume bowel preparation on colonoscopy quality and patient satisfaction: An observational study

Cited by 17 publications

References 30 publications

Efficacy and Tolerability of High and Low-volume Bowel Preparation Compared: a Real-life Single-blinded Large-population Study

Efficacy and Tolerability of High and Low-volume Bowel Preparation Compared: a Real-life Single-blinded Large-population Study

Bring More Data!—A Good Advice? Removing Separation in Logistic Regression by Increasing Sample Size

Patient experience with NER1006 as a bowel preparation for colonoscopy: a prospective, multicenter US survey

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