Low-Volume Polyethylene Glycol for Bowel Preparation in Hospitalized Adults : A Multicenter Randomized Trial

Area of Science:

• Gastroenterology
• Endoscopy
• Clinical Trials

Background:

• Effective bowel preparation is crucial for high-quality colonoscopy.
• Preparation quality is often compromised in hospitalized patients.
• Limited comparative data exist regarding different polyethylene glycol (PEG) preparation volumes.

Purpose of the Study:

• To compare the efficacy, tolerability, and safety of 1-liter (1L), 2-liter (2L), and 4-liter (4L) PEG regimens for inpatient colonoscopy preparation.
• To evaluate bowel cleansing quality using the Boston Bowel Preparation Scale (BBPS).

Main Methods:

• A multicenter, randomized controlled, endoscopist-blinded trial involving hospitalized adults undergoing elective colonoscopy.
• Patients were randomized to receive split-dose 1L PEG-ascorbate, 2L PEG-ascorbate, or 4L PEG.
• Primary endpoint: adequate bowel cleansing (BBPS score ≥6); secondary endpoints: high-quality cleansing (BBPS 8-9), high-quality right-colon cleansing (BBPS 3), and willingness to repeat.

Main Results:

• Adequate overall cleansing rates were similar across groups (82.0% for 1L, 78.0% for 2L, 78.5% for 4L).
• High-quality overall cleansing was significantly higher in the 1L group (46.9%) compared to 2L (35.3%) and 4L (37.4%) groups.
• High-quality right-colon cleansing was also superior in the 1L group (40.6%) versus 2L (29.5%) and 4L (31.6%) groups. Tolerability was good, with the highest willingness to repeat in the 1L group (84.2%).

Conclusions:

• One-liter PEG-ascorbate provides superior high-quality bowel cleansing, including the right colon, compared to 2L and 4L PEG regimens in hospitalized adults.
• The 1L regimen achieved similar adequate cleansing rates and high patient willingness to repeat, suggesting it is a viable option for inpatient colonoscopy preparation.
• This study highlights the potential of very low-volume PEG preparations for optimizing colonoscopy quality in hospitalized patients.