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Effectiveness of low-volume split-dose versus same-day morning polyethylene glycol regimen for adequacy of bowel
K Venkata Anudeep1, Pazhanivel Mohan2, K Senthamizh Selvan1
1Department of Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006, India.
Insights
Same-day polyethylene glycol (PEG) bowel preparation is effective for colonoscopy, showing better results than split-dose regimens. This method is well-tolerated and acceptable, improving patient experience without compromising sleep.
Area of Science:
- Gastroenterology
- Endoscopy
- Clinical Trials
Background:
- Colonoscopy success relies heavily on optimal bowel preparation.
- Polyethylene glycol (PEG) is a standard bowel prep agent.
- Traditional split-dose regimens can disrupt sleep and daily activities.
Purpose of the Study:
- To compare the efficacy, tolerability, and acceptability of same-day PEG versus low-volume split-dose PEG.
- To evaluate bowel preparation quality using the Boston Bowel Preparation Scale (BBPS).
- To assess patient-reported outcomes including sleep interference and satisfaction.
Main Methods:
- A single-blinded randomized controlled trial (RCT) involving 384 patients.
- Two groups: same-day (SD) PEG and split-dose (SPL) PEG, both with bisacodyl.
- Bowel preparation adequacy assessed by BBPS; tolerability and acceptability via symptom reporting and questionnaires.
Main Results:
- Same-day PEG demonstrated significantly higher BBPS scores (median 8 vs. 6, p<0.001) and a greater proportion of adequate preparations (86% vs. 73.4%, p=0.002).
- Tolerability (nausea, vomiting, bloating, pain) and overall satisfaction were similar between groups.
- Split-dose preparation significantly interfered with sleep (54% vs. 14.5%, p<0.001).
Conclusions:
- Same-day morning PEG bowel preparation is an effective alternative for colonoscopy.
- It offers comparable tolerability and acceptability to split-dose regimens.
- This regimen minimizes sleep disruption, enhancing patient compliance and experience.
Background:
Successful completion of colonoscopy depends largely on the quality of bowel preparation. Polyethylene glycol (PEG) is a commonly used preparation for colonoscopy. The timing of bowel preparation has evolved from previous day evening to the currently recommended split-dose regimen. It was observed that consumption of entire or a portion of PEG on the previous day can interfere with work and sleep. Hence, we designed this single-blinded randomized controlled trial (RCT) to evaluate the efficacy, tolerability, and acceptability of the same-day PEG as compared with lowvolume split-dose PEG in patients undergoing late morning colonoscopy.
Methods:
A total of 384 patients were randomized to same-day (SD group; n = 192) and split-dose (SPL group; n = 192) bowel preparation. The patients in both the groups received bisacodyl 10 mg at bedtime on the day prior to colonoscopy. The patients in the SD group took 2 L of PEG between 5:00 AM and 7:00 AM on the day of colonoscopy. The SPL group took 1 L of PEG between 6:00 PM and 7:00 PM on the preceding day and another liter between 6:00 AM and 7:00 AM on the day of colonoscopy. The adequacy of bowel preparation was assessed using the Boston Bowel Preparation Scale (BBPS). Tolerability was scored by recording symptoms such as nausea, vomiting, bloating, and abdominal pain. Acceptability was based on the overall satisfaction, willingness to repeat the same preparation, and interference with sleep on the preceding night.
Results:
The median (interquartile range, [IQR]) BBPS in the SD group was 8 (6-9) while that in the SPL group was 6 (5-8) and this difference was statistically significant (p < 0.001). Similarly, a significantly higher proportion of patients in the SD group (86%) achieved adequate bowel preparation (BBPS score ≥ 6) when compared to those in the SPL group (73.4%) (p = 0.002). Tolerability as assessed by nausea, vomiting, bloating, and abdominal pain was similar in both the groups. There was also no significant difference with respect to overall satisfaction of taking bowel preparation (p = 0.33) or willingness to repeat the same regimen (p = 0.37) between the two groups. Patients in the SPL group had more interference with sleep on the preceding night (54% vs. 14.5%, p < 0.001).
Conclusion:
Same-day morning PEG regimen can be considered an effective, well-tolerated, and acceptable bowel preparation for colonoscopy.
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