Abstract
Introduction: Adequate bowel preparation is indispensable for high-quality colonoscopy. We have developed an ultralow-volume (500 mL) polyethylene glycol (PEG) combined with other laxatives (sennoside, sodium picosulfate, and lactulose) and applied this regimen clinically to all patients with colonoscopy for 3 decades. This study aimed to assess the effectiveness of this ultralow-volume bowel preparation regimen. Methods: This single-center, retrospective study analyzed data from consecutive outpatients who underwent colonoscopy between January 2022 and December 2022. All the patients took sennoside (24 mg) two nights before, sodium picosulfate (75 mg) one night before, and 500 mL of PEG with lactulose (58.5 g) on the day of examination. Cleaning efficacy was evaluated using the Boston Bowel Preparation Scale (BBPS). Adequate bowel preparation was defined as a total BBPS score ≥6, with all colon segments scoring ≥2. Results: Out of 862 patients with colonoscopy, 773 were eligible for this study, and the median age was 66 years. The adequate bowel preparation rate was 91.8% (710/773). Notably, the BBPS full score “9” was observed in 50.5% (390/773). The median cecal intubation time and examination time were 8 and 20 min, respectively. Only 3 patients vomited as a side effect. In the multivariate analysis, age ≥70 years, diabetes mellitus, and diverticula were significantly independent risk factors for inadequate bowel preparation. Conclusions: Our established ultralow-volume (500 mL) PEG is safe and useful as a bowel preparation method.
Journal Section:
Endoscopy and Imaging
References
1.
Bray
F
, Laversanne
M
, Sung
H
, Ferlay
J
, Siegel
RL
, Soerjomataram
I
, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries
. CA Cancer J Clin
. 2024
;74
(3
):229
–63
. 2.
Nishihara
R
, Wu
K
, Lochhead
P
, Morikawa
T
, Liao
X
, Qian
ZR
, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy
. N Engl J Med
. 2013
;369
(12
):1095
–105
. 3.
Harewood
GC
, Sharma
VK
, de Garmo
P
. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia
. Gastrointest Endosc
. 2003
;58
(1
):76
–9
. 4.
Froehlich
F
, Wietlisbach
V
, Gonvers
JJ
, Burnand
B
, Vader
JP
. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study
. Gastrointest Endosc
. 2005
;61
(3
):378
–84
. 5.
Guo
R
, Wang
YJ
, Liu
M
, Ge
J
, Zhang
LY
, Ma
L
, et al. The effect of quality of segmental bowel preparation on adenoma detection rate
. BMC Gastroenterol
. 2019
;19
(1
):119
. 6.
Hassan
C
, East
J
, Radaelli
F
, Spada
C
, Benamouzig
R
, Bisschops
R
, et al. Bowel preparation for colonoscopy: European society of gastrointestinal endoscopy (ESGE) guideline - update 2019
. Endoscopy
. 2019
;51
(8
):775
–94
. 7.
Davis
GR
, Santa Ana
CA
, Morawski
SG
, Fordtran
JS
. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion
. Gastroenterology
. 1980
;78
(5
):991
–5
. 8.
ASGE Standards of Practice Committee
; Saltzman
JR
, Cash
BD
, Pasha
SF
, Early
DS
, Muthusamy
VR
, et al. Bowel preparation before colonoscopy
. Gastrointest Endosc
. 2015
;81
(4
):781
–94
. 9.
Xie
Q
, Chen
L
, Zhao
F
, Zhou
X
, Huang
P
, Zhang
L
, et al. A meta-analysis of randomized controlled trials of low-volume polyethylene glycol plus ascorbic acid versus standard-volume polyethylene glycol solution as bowel preparations for colonoscopy
. PLoS One
. 2014
;9
(6
):e99092
. 10.
Chan
WK
, Azmi
N
, Mahadeva
S
, Goh
KL
. Split-dose vs same-day reduced-volume polyethylene glycol electrolyte lavage solution for morning colonoscopy
. World J Gastroenterol
. 2014
;20
(39
):14488
–94
. 11.
Martel
M
, Barkun
AN
, Menard
C
, Restellini
S
, Kherad
O
, Vanasse
A
. Split-dose preparations are superior to day-before bowel cleansing regimens: a meta-analysis
. Gastroenterology
. 2015
;149
(1
):79
–88
. 12.
Clark
RE
, Godfrey
JD
, Choudhary
A
, Ashraf
I
, Matteson
ML
, Bechtold
ML
. Low-volume polyethylene glycol and bisacodyl for bowel preparation prior to colonoscopy: a meta-analysis
. Ann Gastroenterol
. 2013
;26
(4
):319
–24
.13.
Rex
DK
, Katz
PO
, Bertiger
G
, Vanner
S
, Hookey
LC
, Alderfer
V
, et al. Split-dose administration of a dual-action, low-volume bowel cleanser for colonoscopy: the SEE CLEAR I study
. Gastrointest Endosc
. 2013
;78
(1
):132
–41
. 14.
van Riswijk
MLM
, van Keulen
KE
, Siersema
PD
. Efficacy of ultra-low volume (≤1 L) bowel preparation fluids: systematic review and meta-analysis
. Dig Endosc
. 2022
;34
(1
):13
–32
. 15.
Saito
Y
, Oka
S
, Kawamura
T
, Shimoda
R
, Sekiguchi
M
, Tamai
N
, et al. Colonoscopy screening and surveillance guidelines
. Dig Endosc
. 2021
;33
(4
):486
–519
. 16.
Lai
EJ
, Calderwood
AH
, Doros
G
, Fix
OK
, Jacobson
BC
. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research
. Gastrointest Endosc
. 2009
;69
(3 Pt 2
):620
–5
. 17.
Calderwood
AH
, Schroy
PC
3rd, Lieberman
DA
, Logan
JR
, Zurfluh
M
, Jacobson
BC
. Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness
. Gastrointest Endosc
. 2014
;80
(2
):269
–76
. 18.
Kastenberg
D
, Bertiger
G
, Brogadir
S
. Bowel preparation quality scales for colonoscopy
. World J Gastroenterol
. 2018
;24
(26
):2833
–43
. 19.
Lee
JM
, Keum
B
, Yoo
IK
, Kim
SH
, Choi
HS
, Kim
ES
, et al. Polyethylene glycol plus ascorbic acid for bowel preparation in chronic kidney disease
. Medicine
. 2016
;95
(36
):e4755
. 20.
Ho
SB
, Hovsepians
R
, Gupta
S
. Optimal bowel cleansing for colonoscopy in the elderly patient
. Drugs Aging
. 2017
;34
(3
):163
–72
. 21.
Hassan
C
, Fuccio
L
, Bruno
M
, Pagano
N
, Spada
C
, Carrara
S
, et al. A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy
. Clin Gastroenterol Hepatol
. 2012
;10
(5
):501
–6
. 22.
Chung
YW
, Han
DS
, Park
KH
, Kim
KO
, Park
CH
, Hahn
T
, et al. Patient factors predictive of inadequate bowel preparation using polyethylene glycol: a prospective study in Korea
. J Clin Gastroenterol
. 2009
;43
(5
):448
–52
. 23.
Salari
N
, Ghasemianrad
M
, Ammari-Allahyari
M
, Rasoulpoor
S
, Shohaimi
S
, Mohammadi
M
. Global prevalence of constipation in older adults: a systematic review and meta-analysis
. Wien Klin Wochenschr
. 2023
;135
(15–16
):389
–98
. 24.
Gallagher
P
, O’Mahony
D
. Constipation in old age
. Best Pract Res Clin Gastroenterol
. 2009
;23
(6
):875
–87
. 25.
Kuznik
E
, Dudkowiak
R
, Adamiec
R
, Poniewierka
E
. Diabetic autonomic neuropathy of the gastrointestinal tract
. Prz Gastroenterol
. 2020
;15
(2
):89
–93
. 26.
Camilleri
M
. Gastrointestinal motility disorders in neurologic disease
. J Clin Investig
. 2021
;131
(4
):e143771
. 27.
Piper
MS
, Saad
RJ
. Diabetes mellitus and the colon
. Curr Treat Options Gastroenterol
. 2017
;15
(4
):460
–74
. 28.
Alvarez-Gonzalez
MA
, Flores-Le Roux
JA
, Seoane
A
, Pedro-Botet
J
, Carot
L
, Fernandez-Clotet
A
, et al. Efficacy of a multifactorial strategy for bowel preparation in diabetic patients undergoing colonoscopy: a randomized trial
. Endoscopy
. 2016
;48
(11
):1003
–9
. 29.
Yamamichi
N
, Shimamoto
T
, Takahashi
Y
, Sakaguchi
Y
, Kakimoto
H
, Matsuda
R
, et al. Trend and risk factors of diverticulosis in Japan: age, gender, and lifestyle/metabolic-related factors may cooperatively affect on the colorectal diverticula formation
. PLoS One
. 2015
;10
(4
):e0123688
. 30.
Peery
AF
, Keku
TO
, Martin
CF
, Eluri
S
, Runge
T
, Galanko
JA
, et al. Distribution and characteristics of colonic diverticula in a United States screening population
. Clin Gastroenterol Hepatol
. 2016
;14
(7
):980
–5.e1
. 31.
Peery
AF
, Keku
TO
, Galanko
JA
, Sandler
RS
. Sex and race disparities in diverticulosis prevalence
. Clin Gastroenterol Hepatol
. 2020
;18
(9
):1980
–6
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