Low-volume PEG yields high-quality cleansing for bowel preparation in colonoscopy patients

The use of a 1-litre (L) polyethylene glycol (PEG)-ascorbate in hospitalized adults undergoing elective colonoscopy results in higher rates of high-quality cleansing than a 2L PEG-ascorbate or 4L PEG, reports a study, noting comparable rates of adequate cleansing and high willingness to repeat.

A total of 665 patients were randomly allocated to split-dose 1L PEG-ascorbate (n=228), 2L PEG-ascorbate (n=218), or 4L PEG (n=219) across community and academic hospitals in Italy.

Adequate bowel cleansing (Boston Bowel Preparation Scale [BBPS] score ≥6 with all segments ≥2) was the primary endpoint. Secondary endpoint included high-quality cleansing (BBPS score 8 to 9), high-quality right-colon cleansing (BBPS score 3), and willingness to repeat

Adequate overall cleansing occurred in 82.0 percent of patients in the 1L group, 78.0 percent in the 2L group, and 78.5 percent in the 4L group (absolute difference between the 1L and 2L groups [Δ1L–2L], 4.0 percentage points, 95 percent confidence interval [CI], −3.4 to 11.4; absolute difference between the 1L and 4L groups [Δ1L–4L], 3.5 percentage points, 95 percent CI, −3.9 to 10.9).

High-quality overall cleansing occurred in 46.9 percent, 35.3 percent, and 37.4 percent, respectively (Δ1L–2L, 11.6 percentage points, 95 percent CI, 2.5 to 20.5; Δ1L–4L, 9.5 percentage points, 95 percent CI, 0.3 to 18.5 percentage points).

For high-quality right-colon cleansing, the corresponding rates were 40.6 percent, 29.5 percent, and 31.6 percent (Δ1L–2L, 11.2 percentage points, 95 percent CI, 2.1 to 20.0; Δ1L–4L, 9.0 percentage points, 95 percent CI, 0.0 to 17.9).

All regimens had good tolerability, with the 1L group yielding the highest willingness to repeat (84.2 percent), despite more frequent vomiting and thirst.

The study was limited by the exclusion of patients requiring urgent colonoscopy for active gastrointestinal bleeding and those with severe/unstable comorbid conditions.