Feasibility and tolerability of reduced-volume oral sulfate solution combined with elobixibat for bowel preparation...

Reducing the volume of bowel preparation may improve patient adherence and tolerability without compromising cleansing efficacy. Oral sulfate solution (OSS) is a low-volume preparation option, and elobixibat, a bile acid transporter inhibitor, may enhance colonic secretion and motility. We evaluated the feasibility, efficacy, safety, and tolerability of a same-day regimen combining elobixibat with OSS.

This prospective single-arm pilot study was conducted at Juntendo University Hospital in Japan. Consecutive patients aged 20-64 years scheduled for elective colonoscopy were enrolled between April 2021 and March 2023. Patients received elobixibat (10 mg once daily for 3 days before colonoscopy), followed by same-day OSS using a "stop-when-clear" protocol. The primary outcome was adequate bowel preparation, defined as a total Boston Bowel Preparation Scale (BBPS) score ≥6. Secondary outcomes included OSS volume consumed, adverse events, and patient-reported tolerability assessed by questionnaire.

Twenty-eight patients were analyzed. Adequate bowel preparation was achieved in 96% of patients. BBPS ≥2 were 82% in the right colon, 96% in the transverse colon, and 100% in the left colon. The mean total OSS volume was 771 mL, and 57% of patients completed preparation with ≤720 mL. No serious adverse events were observed. Most patients reported acceptable palatability (82%) and manageable volume (100%). Among those with prior colonoscopy experience, 75% preferred this regimen and 86% indicated willingness to use it again.

A same-day regimen combining elobixibat with OSS demonstrated favorable feasibility, efficacy, and tolerability. Reduced OSS volume may be achievable in selected patients. However, these findings are limited to a relatively low-risk, non-elderly population and should be confirmed in larger comparative studies.