An Enhanced High-Volume Preparation for Colonoscopy Is Not Better Than a Conventional Low-Volume One in Patients at Risk of Poor Bowel Cleansing: A Randomized Controlled Trial

• Main Authors: Antonio Z. Gimeno-García, Goretti Hernández, José Luis Baute Dorta, Cristina Reygosa, Raquel de la Barreda, Alberto Hernandez-Bustabad, Carla Amaral, Yaiza Cedrés, Rocío del Castillo, David Nicolás-Pérez, Alejandro Jiménez, Onofre Alarcon-Fernández, Manuel Hernandez-Guerra, Rafael Romero, Inmaculada Alonso, Yanira González, Zaida Adrian, Domingo Hernandez, Laura Ramos, Marta Carrillo, Vanessa Felipe, Anjara Hernández, Consuelo Rodríguez-Jiménez, Enrique Quintero
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2021-03-01
• Series: Frontiers in Medicine
• Subjects: bowel cleansing predictive score; enhanced bowel preparation; hard to prepare patients; high volume bowel preparation; low volume bowel preparation
• Online Access: https://www.frontiersin.org/articles/10.3389/fmed.2021.654847/full

Objective: We tested the hypothesis that an enhanced bowel preparation strategy (EBS) improves colonic cleansing in patients at high risk for inadequate bowel cleansing (HRI).Methods: This prospective randomized clinical trial included consecutive HRI patients referred for outpatient colonoscopy between February and October 2019. HRI was considered if patients scored >1.225 according to a previously validated bowel-cleansing predictive score. HRI patients were randomized (1:1) to a low-volume conventional bowel cleansing strategy (CBS) (1-day low residue diet (LRD) plus 2 L of polyethylene glycol (PEG) plus ascorbic acid) or to an EBS (3-day LRD plus 10 mg oral bisacodyl plus 4 L PEG). The Boston Bowel Preparation Scale (BBPS) was used to assess the quality of cleanliness. Intention-to-treat (ITT) and per protocol (PP) analyses were performed. A sample size of 130 patients per group was estimated to reach a 15% difference in favor of EBP.Results: A total of 253 HRI patients were included (mean age 69.8 ± 9.5 years, 51.8% women). No statistically significant differences were found in the BBPS scale between the two groups in the ITT analysis (CBS 76.8% vs. EBS 79.7%, P = 0.58) or PP analysis (CBS 78% vs. EBS 84.3%, P = 0.21), risk difference 2.9% (95% CI−7.26 to 39.16) in the ITT analysis, or risk difference 6.3% (95% CI−3.48 to 16.08) in PP analysis. No differences in preparation tolerance, compliance, adverse effects, or colonoscopy findings were found.Conclusion: EBS is not superior to CBS in hard-to-prepare patients. (EUDRACT: 2017-000787-15, NCT03830489).Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03830489.