The Bowel CLEANsing National Initiative: High-Volume Split-Dose Vs Low-Volume Split-Dose Polyethylene Glycol Preparations: A Randomized Controlled Trial

Barkun, Alan N.; Martel, Myriam; Epstein, Ian; Hallé, Pierre; Hilsden, Robert J.; James, Paul D.; Rostom, Alaa; Sey, Michael; Singh, Harminder; Sultanian, Richard; Telford, Jennifer J.; Renteln, Daniel von

doi:10.1016/j.cgh.2021.09.005

Cited by 6 publications

(5 citation statements)

References 25 publications

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“…In a recent study, high-volume PEG (2L + 2L) yielded clinically similar results compared with low-volume PEG (1L + 1L) plus bisacodyl (15 mg); however, patients' willingness to repeat and their tolerability were superior in the low-volume group ( 27 ). For patients in the difficult-to-cleanse population, the PEG 2+2L + bisacodyl was more efficacious in bowel cleansing than the PEG 4+2L + bisacodyl ( 28 ). These results showed that the high-volume PEG alone is not the optimal strategy for patients with risk factors for inadequate bowel preparation.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Polyethylene Glycol Electrolyte Powder Combined With Linaclotide for Colon Cleansing in Patients With Chronic Constipation Undergoing Colonoscopy: A Multicenter, Single-Blinded, Randomized Controlled Trial

Wang,

Zhang,

et al. 2024

Clin Transl Gastroenterol

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Background and aims: Constipation is an independent risk factor for poor bowel preparation. This study aimed to evaluate the bowel-cleansing efficacy and safety of polyethylene glycol (PEG) combined with linaclotide (lin) for colonoscopy in patients with chronic constipation. Methods: This single-blinded, randomized, controlled and multicenter study was conducted from July 2021 to December 2022 at seven hospitals. Patients with chronic constipation who underwent colonoscopies were enrolled and randomly assigned to 4 groups with split -PEG regimens: 4L-PEG group, 4L-PEG+1d-Lin group, 3L-PEG+1d-Lin group, and 3L-PEG+3d-Lin group. The primary outcome was rates of adequate bowel preparation, defined as a total BBPS score ≥6 and a score ≥2 for each segment. Secondary outcomes were adverse effects, sleep quality, willingness to repeat the colonoscopy, adenoma detection rate, and polyp detection rate. Results: 502 patients were enrolled. The rates of adequate bowel preparation (80.0% vs. 60.3%, P<0.001; 84.4% vs. 60.3%, P<0.001) and the total BBPS scores (6.90±1.28 vs. 6.00±1.61, P<0.001; 7.03±1.24 vs. 6.00±1.61, P<0.01) in 4L-PEG+1d-Lin group and 3L-PEG+3d-Lin group were superior to that in 4L-PEG group. Compared with 4L-PEG group, 4L-PEG+1d-Lin group (66.7% vs. 81.7%, P=0.008) and 3L-PEG+3d-Lin group (75.0% vs. 81.7%, P=0.224) had a lower percentage of mild adverse events. No statistically significant difference in willingness to repeat the colonoscopy, sleep quality, polyp detection rate, or adenoma detection rate was observed among groups. Conclusions: PEG combined with linaclotide might be an effective method for bowel preparation before colonoscopy in patients with chronic constipation.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Polyethylene Glycol Electrolyte Powder Combined With Linaclotide for Colon Cleansing in Patients With Chronic Constipation Undergoing Colonoscopy: A Multicenter, Single-Blinded, Randomized Controlled Trial

Wang,

Zhang,

et al. 2024

Clin Transl Gastroenterol

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“…In addition, this study was performed in an outpatient setting and may not be generalized to hospitalized patients receiving similar regimens, but the limited data from one of the studies on hospitalized patients showed similar results, suggesting that it may be reasonable to generalize our results to this group. Patients' dietary habits were not evaluated in this substudy, but in the parent study, we reported that the overall impact of diet was modest on bowel cleansing (15).…”

Section: Discussionmentioning

confidence: 99%

“…This is a substudy of patients enrolled in a prospective, multiarm, endoscopist-blinded, randomized control trial (RCT) in 10 endoscopy centers in Canada forming the Bowel CLEANsing National Initiative (BCLEAN). The trial assessed the efficacy of 3 different polyethylene glycol (PEG)-based bowel preparation regimens with stratification according to the time of the scheduled colonoscopy and diet, for a total of 6 treatment arms (details are provided in previous publications) (11,15). This study was approved by the research ethic boards from all sites and was registered at clinicaltrials.gov (NCT02547571).…”

Section: Methodsmentioning

confidence: 99%

“…There are 2 essential measures which guide the selection of bowel preparation regimens-effectiveness for bowel cleanliness and patient tolerance. Overall, split-dose regimens are superior to day-before regimens (7)(8)(9)(10) and equivalent (11)(12)(13) or slightly inferior (14) to same-day regimens for bowel cleanliness (15). However, many patients and practices continue to be reluctant to use split-dose bowel preparation regimens for early morning colonoscopies because of concern of patient tolerance related to decreased sleep and impact on activities, especially travel interruption due to bowel movements (BMs) on the day of the procedure (16).…”

Section: Introductionmentioning

confidence: 99%

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Sleep Disturbances, Bowel Movement Kinetics, and Travel Interruption With Bowel Preparation: A Bowel CLEANsing National Initiative Substudy

et al. 2022

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INTRODUCTION: We investigated sleep disturbances, bowel movement (BM) kinetics, and travel experience with different bowel preparation regimens in a substudy of patients enrolled in a randomized multicenter Canadian clinical trial. METHODS:Patients scheduled to have a colonoscopy between 7:30 AM and 10:30 AM (early morning) were randomized to (i) 4-L single-dose polyethylene glycol (PEG) given in the evening before, (ii) 2-L splitdose PEG (1bisacodyl 15 mg), or (iii) 4-L split-dose PEG. Patients scheduled to undergo a colonoscopy between 10:30 AM and 4:30 PM (afternoon) were randomized to (iv) 2-L single-dose PEG (1bisacodyl 15 mg) in the morning, (v) 2-L split-dose PEG (1bisacodyl 15 mg), or (vi) 4-L split-dose PEG. Patients were asked to record information on BM kinetics, sleep, and travel to the endoscopy unit. Continuous and categorical variables were compared between groups using a Kruskal-Wallis test or x 2 test, respectively. Intention-to-treat analyses were performed. RESULTS:Overall, 641 patients were included in this substudy. Patients undergoing early morning colonoscopies reported the most awakenings in the night when assigned to 4-L single-dose day-before PEG and the highest reduction in sleep hours when assigned to 4-L split-dose PEG. There were no significant between-group differences in urgent BMs, fecal incontinence episodes, or travel interruptions. Overall, 17% of those traveling for more than an hour had to stop for a BM during travel, with no significant difference between groups.DISCUSSION:Day-before and split-dose high-volume PEG regimens for colonoscopies scheduled before 10:30 AM lead to the greatest sleep disturbance.

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“…We thank Dr Kai and colleagues for their letter addressing selected aspects our recent work entitled "The Bowel CLEANsing National Initiative: High-Volume Split-Dose Vs Low-Volume Split-Dose Polyethylene Glycol Preparations: A Randomized Controlled Trial." 1 We address each of the issues in turn in the order raised by the readers.…”

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Barkun¹,

Martel²

2022

Clinical Gastroenterology and Hepatology

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The Bowel CLEANsing National Initiative: High-Volume Split-Dose Vs Low-Volume Split-Dose Polyethylene Glycol Preparations: A Randomized Controlled Trial

Cited by 6 publications

References 25 publications

Efficacy of Polyethylene Glycol Electrolyte Powder Combined With Linaclotide for Colon Cleansing in Patients With Chronic Constipation Undergoing Colonoscopy: A Multicenter, Single-Blinded, Randomized Controlled Trial

Efficacy of Polyethylene Glycol Electrolyte Powder Combined With Linaclotide for Colon Cleansing in Patients With Chronic Constipation Undergoing Colonoscopy: A Multicenter, Single-Blinded, Randomized Controlled Trial

Sleep Disturbances, Bowel Movement Kinetics, and Travel Interruption With Bowel Preparation: A Bowel CLEANsing National Initiative Substudy

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