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Efficacy and Safety of Low Volume Bowel Preparation for Colonoscopy in Hospitalized Patients: A Randomized
Karen Xiao1, Fatima Khan1, Richard Link2
1Section of Digestive Diseases, Department of Medicine,, Yale School of Medicine, New Haven, CT.
Goals:
To evaluate whether low-volume bowel preparation achieved similar rates of bowel cleansing as standard volume bowel preparations among hospitalized patients and assess the tolerability and safety of their use in this population.
Background:
The use of low-volume bowel preparations for colonoscopy preparation is understudied in the inpatient setting, where standard volume preparations remain the standard of care.
Methods:
We conducted a multicenter, randomized, single-blind, noninferiority trial. Hospitalized adult patients were randomized to receive low volume (2 L polyethylene glycol and ascorbic acid, 2L PEG+ASC) or standard volume bowel preparation (4 L polyethylene glycol and electrolyte lavage solution, 4L PEG-ELS) before colonoscopy. The primary outcome was noninferiority with respect to the achievement of adequate bowel preparation. Secondary outcomes included rates of electrolyte derangements, acute kidney injury, and patient tolerability.
Results:
Five hundred twenty patients were randomized to 2L PEG+ASC (n=257) and 4L PEG-ELS (n=263). In per-protocol analysis, 2L PEG+ASC was noninferior to 4L PEG-ELS for achievement of adequate bowel preparation (55.0% vs. 52.9%, P=0.007). No significant difference was detected with regard to hyponatremia (1.6% vs. 3.3%, P=0.50), hypokalemia (5.3% vs. 8.7%, P=0.27), hyperkalemia (1.1% vs. 0.0% P=0.24), or acute kidney injury (4.3% vs. 3.3%, P=0.73). More 2L PEG+ASC patients found the preparation to be "easy" to tolerate compared with 4L PEG-ELS patients (29.0% vs. 13.1%, P<0.001).
Conclusions:
Among hospitalized patients, 2L PEG+ASC was noninferior to 4L PEG-ELS for achieving bowel cleanliness with similar rates of electrolyte disturbance and acute kidney injury and with higher tolerability (ClinicalTrials.gov number, NCT05054036).
Insights
Low-volume bowel preparation (2L PEG+ASC) effectively cleanses the bowel in hospitalized patients, matching standard volumes. This method offers similar safety and improved patient tolerability for colonoscopy.
Area of Science:
- Gastroenterology
- Clinical Trials
- Patient Safety
Background:
- Low-volume bowel preparations are understudied in hospitalized patients.
- Standard volume preparations are the current inpatient standard of care for colonoscopy.
Purpose of the Study:
- To compare the efficacy of low-volume (2L PEG+ASC) versus standard-volume (4L PEG-ELS) bowel preparation in hospitalized patients.
- To assess the tolerability and safety of these preparations in an inpatient setting.
Main Methods:
- A multicenter, randomized, single-blind, noninferiority trial involving 520 hospitalized adult patients.
- Patients received either 2L PEG+ASC or 4L PEG-ELS before colonoscopy.
- Primary outcome: adequate bowel preparation; Secondary outcomes: electrolyte derangements, acute kidney injury, and tolerability.
Main Results:
- 2L PEG+ASC was noninferior to 4L PEG-ELS for adequate bowel preparation (55.0% vs. 52.9%, P=0.007).
- No significant differences in hyponatremia, hypokalemia, hyperkalemia, or acute kidney injury rates.
- Significantly higher tolerability reported for 2L PEG+ASC (29.0% vs. 13.1%, P<0.001).
Conclusions:
- 2L PEG+ASC is a noninferior alternative to 4L PEG-ELS for bowel cleansing in hospitalized patients.
- The low-volume preparation demonstrates comparable safety regarding electrolyte balance and kidney function.
- Improved patient tolerability supports the use of 2L PEG+ASC in inpatient colonoscopy preparation.
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