Efficacy of 1 L polyethylene glycol plus ascorbate versus 4 L polyethylene glycol in split-dose for colonoscopy cleansing in out and inpatient: A multicentre, randomized trial (OVER 2019)

Area of Science:

• Gastroenterology
• Endoscopic procedures
• Colorectal cancer screening

Background:

• Adequate bowel cleansing is crucial for colonoscopy quality and accurate diagnoses.
• High-volume polyethylene glycol (PEG) solutions are standard but can be burdensome for patients.
• A novel 1 L PEG plus ascorbate (1 L PEG+ASC) solution offers a lower-volume alternative.

Purpose of the Study:

• To compare the efficacy of 1 L PEG+ASC with high-volume 4 L PEG for colon cleansing.
• To evaluate cleansing success, particularly in the right colon, in both inpatient and outpatient settings.
• To assess patient compliance, tolerability, and safety of the 1 L PEG+ASC preparation.

Main Methods:

• A single-blinded, non-inferiority randomized controlled trial was conducted.
• Patients undergoing colonoscopy were assigned to receive either split-dose 1 L PEG+ASC or 4 L PEG.
• Primary endpoint: overall cleansing success; Secondary endpoints: quality of right colon cleansing, lesion detection, compliance, tolerability, and safety.

Main Results:

• The 1 L PEG+ASC group demonstrated a significantly higher overall cleansing success rate (91.8% vs. 83.6%; P=0.01).
• High-quality cleansing of the right colon was superior with 1 L PEG+ASC (52.3% vs. 38.5%; P=0.004).
• 1 L PEG+ASC showed higher success in outpatients (96.3% vs. 88.6%; P=0.018) and comparable rates in inpatients (84.7% vs. 76.7%; P=0.18).

Conclusions:

• 1 L PEG+ASC is more effective than 4 L PEG for achieving adequate colon cleansing, with a notable advantage in right colon preparation.
• The novel low-volume preparation offers comparable tolerability and safety profiles to the high-volume solution.
• 1 L PEG+ASC represents a promising alternative for bowel preparation, potentially improving patient experience and colonoscopy outcomes.