Split-dose menthol-enhanced PEG vs PEG-ascorbic acid for colonoscopy preparation.

Area of Science:

• Gastroenterology
• Clinical Trials
• Medical Devices

Background:

• Colonoscopy requires effective bowel preparation for optimal visualization.
• Patient adherence to bowel preparation regimens is often limited by palatability.
• Existing polyethylene glycol (PEG) preparations vary in volume and formulation.

Purpose of the Study:

• To compare the efficacy and palatability of 4 L PEG with sugar-free menthol candy (PEG + M) against a reduced-volume 2 L ascorbic acid-supplemented PEG (AscPEG).
• To assess patient acceptance and willingness to repeat the bowel preparation.
• To evaluate the quality of colon cleansing using validated scales.

Main Methods:

• A randomized controlled trial enrolled ambulatory patients scheduled for elective colonoscopy.
• Patients received either PEG + M or AscPEG, administered in a split-dose regimen with minimal dietary restrictions.
• Palatability was self-reported on a 1-5 scale, and preparation quality was assessed by blinded endoscopists using the modified Aronchick and Ottawa scales.

Main Results:

• PEG + M demonstrated significantly better palatability (76% vs 62%, P=0.03) and higher patient willingness to retake the preparation (54% vs 40%, P=0.047) compared to AscPEG.
• No significant difference in overall adequate cleansing was observed between the groups (Aronchick: 82% vs 77%; Ottawa: 85% vs 74%).
• However, PEG + M showed superiority in left colon cleansing on the Ottawa scale (94% vs 81%, P=0.005) and achieved more excellent ratings on the Aronchick scale (61% vs 43%, P=0.009).

Conclusions:

• Four liters of PEG plus menthol offers superior palatability and patient acceptability compared to 2 L AscPEG.
• PEG + M is associated with a higher rate of excellent colon preparations, particularly in the left colon.
• The findings suggest PEG + M may improve patient experience and compliance in bowel preparation for colonoscopy.