Impact of Bowel Preparation with Low-Volume (2-Liter) and Intermediate-Volume (3-Liter) Polyethylene Glycol on Colonoscopy Quality: A Prospective Observational Study

Abstract

Background/Aims: Two-liter polyethylene glycol (PEG) is the most commonly used bowel-cleansing regimen in Taiwan, but its efficacy is unsatisfactory. The aim of this study was to compare 2-liter and 3-liter PEG in terms of their impact on colonoscopy quality among an average-risk population. Methods: Two-liter PEG was provided between August 2012 and May 2013, while 3-liter PEG was provided between June 2013 and March 2014. A split-dose regimen was provided for morning colonoscopy and a same-day regimen was provided for afternoon colonoscopy. The level of bowel cleansing was prospectively scored. Results: A total of 407 consecutive subjects completed the 2-liter regimen, and another 407 consecutive subjects completed the 3-liter regimen. The 3-liter group had a significantly higher rate of excellent or good preparations, equivalent to a Boston bowel preparation scale of ≥7, than the 2-liter group (90 vs. 73%, p < 0.0001). More subjects in the 3-liter preparation group compared with the 2-liter group had overall adenoma (70 vs. 54%, p < 0.0001), proximal adenoma (47 vs. 35%, p = 0.0006), sessile serrated adenoma (28 vs. 6%, p < 0.0001), and advanced adenoma (21 vs. 9%, p < 0.0001). Conclusions: Three-liter PEG provided better cleansing quality and higher adenoma detection rate than 2-liter PEG.

Simethicone improves bowel cleansing with low-volume polyethylene glycol: a multicenter randomized trial

“…The percentage of acceptable bowel preparation was significantly higher in the simethicone group (88.2 %) than in the conventional group (76.6 %). This percentage is similar to that reported with intermediate-volume (3 L split-dosing) PEG solution and comparable to that reported for high-volume (4 L split-dosing) PEG solution in previous studies [2,6,30,31].…”

Split‐dose 4‐L polyethylene glycol regimen for patients with previous colorectal surgery in bowel preparation before colonoscopy: A randomized, controlled, single‐blind study

“…The primary end‐point of the trial was the rate of successful bowel preparation, defined as a total Aronchick score ≤3. According to the previous studies and our clinical experiences, we conservatively estimated that the proportion of successful bowel preparation was 75% in the 2‐MO group in our study. In comparison, a successful bowel preparation can be achieved in approximately 91.6% of patients with colorectal resection in the Western countries with a 4‐L PEG regimen .…”

“…5,6 In the Western countries a 4-L PEG regimen is conventionally applied. 5 While a 2-L PEG regimen alone in the absence of any additional laxatives such as ascorbic acid or bisacodyl is recommended in some Asian countries (e.g., China, Japan, India and Singapore), [7][8][9][10][11][12][13][14] possibly because the Asian populations tend to have a smaller body type and a worse tolerance to the bowel preparation regimen. Colorectal surgery is an independent predictive factor for inadequate bowel preparation, [15][16][17] and the 2-L PEG regimen has not achieved satisfactory bowel preparation results in clinical practice in patients with a history of previous colorectal surgery.…”

“…Colorectal surgery is an independent predictive factor for inadequate bowel preparation, and the 2‐L PEG regimen has not achieved satisfactory bowel preparation results in clinical practice in patients with a history of previous colorectal surgery. The dose of PEG is a key factor that affects the quality of bowel preparation, and a 4‐L PEG regimen has been reported to be sufficient for improving the quality of bowel preparation in such patients.…”

Predicting Suboptimal Bowel Preparation: Taking It Up a PEG

“…Furthermore, PEG-based regimens are associated with a significantly greater number of adverse events, likely due to the inherently larger volume and salty taste of the mixture [9], of particular significance in an Asian population, due to a smaller body size compared to a Caucasian population. In this regard, the same authors in a different publication prospectively compared a 2L PEG versus a 3L PEG solution in a Taiwanese cohort, demonstrating that the 3L regimen was associated with significantly superior cleansing as well as a higher adenoma detection rate (ADR) [10]; hence, the intermediate-volume PEG was evaluated in the current study. While the observed findings have implications for clinical practice, especially for an Asian cohort, there are a few salient points worth mentioning.…”