Bowel Preparation for Colonoscopy: The Patient Point of View.

Area of Science:

• Gastroenterology
• Clinical Pharmacology

Background:

• Colonoscopy requires effective bowel preparation, with polyethylene glycol-asc (PEG-ASC) commonly used despite patient complaints regarding split-dose schedules.
• Mannitol presents a palatable, low-volume alternative with rapid action, making it a potential substitute for PEG-ASC.

Purpose of the Study:

• To compare the patient-reported acceptability and tolerability of same-day oral mannitol versus split-dose 2L PEG-ASC for colonoscopy preparation.
• To evaluate the impact of mannitol and PEG-ASC on patient satisfaction, symptoms, and activity limitations using the Bowel Cleansing Impact Review (BOCLIR) questionnaire.

Main Methods:

• A Phase III international, multicenter, randomized study (SATISFACTION) involving 476 patients who completed the BOCLIR questionnaire.
• Patients were randomized to receive either same-day oral mannitol or a split-dose regimen of 2L PEG-ASC.
• The BOCLIR questionnaire assessed patient experience on scales for satisfaction, symptoms, and activity limitations, with higher scores indicating worse experiences.

Main Results:

• A statistically significant difference in the total BOCLIR score was observed, favoring mannitol (least square means difference: -8.01; 95% CI: -10.70 to -5.31; p < 0.0001).
• Mannitol demonstrated superior patient-reported outcomes in terms of acceptability and tolerability compared to PEG-ASC.
• The results indicate a markedly better patient experience with mannitol bowel preparation.

Conclusions:

• Bowel preparation with mannitol is significantly more acceptable and tolerable for patients compared to PEG-ASC.
• Mannitol represents a highly preferable option for colonoscopy preparation from the patient's perspective.
• Mannitol may be considered a near-ideal bowel preparation agent based on patient-reported outcomes.