Mayur Brahmania, MD at St. Paul’s Hospital in Vancouver, British Columbia, Canada discusses his original article “2L vs. 4L PEG 3350 + electrolytes for outpatient colonic preparation: a randomized controlled trial” from the March issue.

Low volume bowel preparations are ideal to ensure patient compliance, enabling high quality examinations. We examined the bowel-cleansing efficacy and patient tolerability of split-dose 2L PEG3350 + electrolytes (PEG3350e) with 15mg bisacodyl vs. the split-dose 4L PEG3350 + electrolytes (PEG3350e) in a single blinded, non-inferiority randomized controlled trial. Efficacy was assessed using the Boston Bowel Preparation Scale (BBPS) and Ottawa Bowel Preparation Scale (OBPS). Patient satisfaction and tolerability were assessed using a short survey.

Although numerous previous studies have been done on low volume preps our study differs in that:
1) Previous low volume prep studies did not use validating bowel scoring scales.
2) Previous low volume prep studies did not use split dosing regimens.
3) Previous low volume prep studies did not assess individual colonic segments.

Three hundred twenty-five patients were included in the intention-to-treat analysis (51% male) with a mean age of 56 (SD 11.2). No statistically significant difference in cleanliness was found using the BBPS (intention-to-treat P=.381; per-protocol P=.387) and OBPS (intention-to-treat P=.285; per- protocol P=.334). 2L PEG3350e participants found the preparation easy to consume and were willing to repeat the procedure more often than the 4L group (P<.001).

Figure 1. Patient recruitment and randomization. PGE3350e, polyethylene glycol with electrolytes.

Ongoing studies looking at other low-volume preparations given in split-dose fashion such as Pico-Salax (picosulfate, magnesium oxide, and citric acid) and MoviPrep (PEG-3350, sodium sulfate, sodium chloride, potassium chloride, sodium ascorbate and ascorbic acid) along with low residue diets should  provide the endoscopist a range of bowel preparations to choose from as well as being acceptable to patients.

Low volume preps in a split dose can safely be used without compromising bowel-cleansing quality for outpatient colonoscopies. Low volume preps will also enhance patient compliance and tolerability, which has implications for adherence to ingestion and also to colorectal cancer screening guidelines.

Find this article on pages 408-416 of the print journal or read the abstract online.

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