Bowel Preparation for Colonoscopy: The Patient Point of View

Colonoscopy is a common procedure that requires adequate bowel preparation. Polyethylene glycol (PEG) is widely used but commonly associated with patient complaints, including the split-dose administration schedule. Mannitol could be an attractive alternative as it acts quickly, requires low volumes, and is palatable. A recent Phase III international, multicenter, randomized study (SATISFACTION) compared the efficacy and safety of bowel preparation using same-day oral mannitol or a split-dose regimen of 2L PEG-ASC. This study investigated the effects of the two laxatives on the Bowel Cleansing Impact Review (BOCLIR), a questionnaire exploring the degree of satisfaction of patients undergoing preparation for a colonoscopy.

The BOCLIR measures the acceptability and tolerability of bowel cleansers on three unidimensional scales (satisfaction, symptoms, and activity limitations). The total score is the sum of the three sub-scores and ranges from 0 to 110, with higher scores representing worse patient experiences.

This analysis included 476 patients who completed the BOCLIR questionnaire: 236 in the mannitol group and 240 in the PEG-ASC group. The difference in the least square means of the total score was -8.01 (95% CI: -10.70 to -5.31), with a highly significant difference in favor of mannitol (p < 0.0001).

This analysis of the SATISFACTION study shows that bowel preparation with mannitol was far preferable to PEG-ASC in terms of acceptability and tolerability. Based on these results, mannitol may be close to an ideal preparation from the patient's point of view.