A Multicenter Randomized Controlled Trial Comparing Two Bowel Cleansing Regimens for Colonoscopy After Failed Bowel...

Area of Science:

• Gastroenterology
• Endoscopy
• Colorectal Cancer Screening

Background:

• Failed bowel preparation is a common challenge in colonoscopy.
• Optimal regimens for repeat colonoscopy after initial preparation failure are not well-established.
• High-volume preparations are often used but lack robust study.

Purpose of the Study:

• To compare the efficacy, tolerability, and safety of two split-dose polyethylene glycol (PEG) regimens for patients with prior failed bowel preparation.
• To evaluate bowel cleansing effectiveness and patient experience with different PEG volumes.

Main Methods:

• A multicenter, endoscopist-blinded randomized controlled trial involving 196 patients with previous inadequate bowel preparation.
• Patients received either 2 L + 2 L PEG or 4 L + 2 L PEG, both preceded by bisacodyl and combined with dietary restrictions.
• Adequate bowel preparation was assessed using the Boston Bowel Preparation Scale; secondary outcomes included adenoma detection rates and tolerability.

Main Results:

• Both PEG regimens achieved adequate bowel preparation in over 87% of patients, with no significant difference between the 2 L+2 L and 4 L+2 L groups (91.2% vs 87.6%).
• Adenoma detection rates, advanced adenoma detection rates, sessile serrated lesion detection, and cecal intubation rates were similar between the groups.
• While both regimens were well tolerated, the 2 L+2 L PEG group reported a significantly higher willingness to repeat the preparation (91.2% vs 66.2%).

Conclusions:

• A split-dose 4 L polyethylene glycol (PEG) regimen with bisacodyl and dietary modifications is an effective option for patients with prior failed bowel preparation.
• This regimen demonstrates comparable efficacy to higher-volume preparations.
• The 4 L PEG regimen should be considered for repeat colonoscopy attempts due to its efficacy and patient acceptance.