Same-day single-dose <i>vs</i> large-volume split-dose regimens of polyethylene glycol for bowel preparation: A systematic review and meta-analysis

Hui, Pei; Zheng, Xiaojiao; Fang, Chaoying; Liu, Lan-Zai; Chen, Jiansu; Wang, Chao; Chen, Yu-Dai; Huang, Jianmin; Zhou, Yu-Shen; He, Lei

doi:10.12998/wjcc.v10.i22.7844

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…Also, two meta-analyses (including 11 and 14 RCTs) compared split-dose bowel preparation with same-day bowel preparation and found similar results in terms of bowel preparation quality, patient willingness to repeat it, and overall tolerability[ 31 , 32 ].…”

Section: Factors Influencing the Quality Of Bowel Preparationmentioning

confidence: 99%

Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature

Shahini¹,

Sinagra²,

Vitello³

et al. 2023

World J Gastroenterol

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Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection. Nevertheless, almost a quarter of procedures are still carried out with suboptimal preparation, resulting in longer procedure times, higher risk of complications, and higher likelihood of missing lesions. Current guidelines recommend high-volume or low-volume polyethylene glycol (PEG)/non-PEG-based split-dose regimens. In patients who have had insufficient bowel cleansing, the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option. A strategy that includes a prolonged low-fiber diet, a split preparation regimen, and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly. Furthermore, even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients, clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients. Patients with severe renal insufficiency (creatinine clearance < 30 mL/min) should be prepared with isotonic high volume PEG solutions. Few data on cirrhotic patients are currently available, and no trials have been conducted in this population. An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation, especially in patients undergoing resection of left colon lesions, where intestinal preparation has a poor outcome. The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients, as well as strategies to improve colonoscopy preparation in these patients.

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Section: Factors Influencing the Quality Of Bowel Preparationmentioning

confidence: 99%

Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature

Shahini¹,

Sinagra²,

Vitello³

et al. 2023

World J Gastroenterol

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“…16,17 Low-volume preparations are better tolerated by patients, which likely contributes to better compliance in completing the preparation correctly. In contrast, high-volume solutions often cause adverse reactions like nausea, vomiting, abdominal pain, and sleep disturbances, 18 leading patients to discontinue the preparation procedure, consequently reducing compliance.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the adequacy of bowel preparation in patients undergoing colonoscopy: a retrospective study

Di Matteo,

Gota,

Bina

et al. 2024

Work Paper Public Hlth

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Background: a colonoscopy is crucial for detecting Colorectal Cancer (CRC), and its success is reliant on various fac- tors, notably colon cleansing. Investigating the frequency of procedure interruptions due to inadequate bowel prepara- tion and associated predictive factors could inform targeted interventions. This study aimed to retrospectively assess inadequate bowel preparation rates in outpatient and inpatient settings. Materials and Methods: this observational, retrospective, and single-center study examines patient records from a sin- gle hospital in northern Italy. This investigation involves individuals who underwent colonoscopies from January 1, 2021, to December 31, 2021, regardless of whether they were receiving outpatient or inpatient care. Results: this study included 1977 participants. The median age of all participants was 64 years, with ages ranging from 41 to 86. Among males, the median age was 65 years, varying from 56 to 74, whereas for females, it was 64 years, rang- ing from 55 to 74. The majority (78.7%) of participants came from their homes. The type of product used for colon preparation was evaluated in 1783 patients: 92% of them used an osmotic action product (55.7% high volume, 36.3% low volume). The adequacy of the colon preparation for the procedure, assessed using the Boston Bowel Preparation Scale, was found to be poor (score≤5) for 24.2% of the participants, with 13.5% scoring 0. Conclusions: the study suggests healthcare providers should enhance patient education for colonoscopy preparation, especially focusing on hospitalized patients with higher rates of inadequate preparation. Strategies should align with guidelines but also prioritize personalized approaches.

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“…Same-day dosing on the day of colonoscopy has been shown to be as effective as overnight split dosing 26 27 . In the current study, high rates of overall colon cleansing success and high-quality cleansing in the right colon were attained with both the same-day and the overnight split-dosing regimens, although results were greater for the overnight split-dosing regimen.…”

Section: Discussionmentioning

confidence: 99%

Bowel cleansing effectiveness and safety of 1L PEG + Asc in the real-world setting: Observational, retrospective, multicenter study of over 13000 patients

López-Jamar,

Gorjão,

Cotter

et al. 2023

Endosc Int Open

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Background and study aims Effective bowel cleansing is critical for detecting lesions during colonoscopy, highlighting the importance of bowel preparations. 1L polyethylene glycol (PEG) + ascorbate (Asc) is the only recommended 1L PEG product in Europe and the United States. Its efficacy was demonstrated in large-scale controlled trials and confirmed in smaller-scale real-world studies. However, no large-scale real-world data exist. Patients and methods This observational, retrospective, multicenter study, used outpatient follow-up data from medical records from 10 centers in Spain and two in Portugal. Outpatients aged ≥18 years using 1L PEG + Asc as bowel preparation were included. The main outcome measures were overall adequate colon cleansing (Boston Bowel Preparation Scale [BBPS] score ≥6 with BBPS score ≥2 in each segment) and high-quality cleansing of the right colon (BBPS score=3). Results Data from 13169 eligible patients were included. Overall cleansing success was achieved in 89.3% (95%CI 88.7%-89.8%) and high-quality cleansing in the right colon in 49.3% (95%CI 48.4%–50.2%) of patients. For the overnight split-dose and same-day regimens, overall adequate quality cleansing success rate was 94.7% and 86.7% (P<0.0001) and high-quality cleansing of the right colon rate was 65.4% and 41.4% (P<0.0001), respectively. Colonoscopy was completed in 97.3% of patients, with non-completion due to poor preparation in only 0.8%; 2.3% of patients experienced at least one adverse event (AE). Conclusions This large-scale, real-world study demonstrates the effectiveness of 1L PEG + Asc in the total and right colon, with a low percentage of patients with AEs in routine clinical practice.

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Same-day single-dose vs large-volume split-dose regimens of polyethylene glycol for bowel preparation: A systematic review and meta-analysis

Cited by 5 publications

References 32 publications

Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature

Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature

Assessment of the adequacy of bowel preparation in patients undergoing colonoscopy: a retrospective study

Bowel cleansing effectiveness and safety of 1L PEG + Asc in the real-world setting: Observational, retrospective, multicenter study of over 13000 patients

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