Low-volume plus ascorbic acid vs high-volume plus simethicone bowel preparation before colonoscopy

Area of Science:

• Gastroenterology
• Endoscopy
• Colorectal Cancer Screening

Background:

• Effective bowel preparation is crucial for successful colonoscopy and accurate polyp detection.
• Traditional high-volume bowel preparations can be associated with poor patient tolerance.
• Low-volume preparations offer potential for improved patient compliance.

Purpose of the Study:

• To compare the effectiveness of two bowel preparation regimens: low-volume polyethylene glycol plus ascorbic acid (PEG + Asc) and high-volume polyethylene glycol plus simethicone (PEG + Sim).
• To evaluate patient acceptability and endoscopist-assessed cleansing quality for both preparations.
• To determine the impact of preparation type on the detection of colorectal lesions.

Main Methods:

• A randomized controlled trial involving 144 outpatients undergoing colonoscopy.
• Patients were assigned to receive either PEG + Asc or PEG + Sim bowel preparation.
• Patient-reported outcomes (acceptability, adverse experiences) and endoscopist assessments (cleansing effectiveness, lesion detection) were collected using validated questionnaires and standardized methods.

Main Results:

• Both PEG + Asc (91%) and PEG + Sim (88%) achieved adequate global bowel cleansing.
• PEG + Sim showed significantly better bowel wall visualization compared to PEG + Asc.
• The PEG + Sim group diagnosed more adenomas ≤ 10 mm, suggesting improved visualization of small lesions.

Conclusions:

• Polyethylene glycol plus simethicone (PEG + Sim) is an effective bowel preparation with enhanced visualization capabilities.
• While PEG + Asc is a viable alternative, PEG + Sim may offer advantages in detecting smaller colorectal lesions.
• Further optimization of bowel preparation strategies is needed to achieve perfect colon cleansing.