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Asgari A, Ziamanesh F, Aliasgari A, Sohrabpour AA. Incidence and predicting factors of inadequate bowel preparation for colonoscopy: A cross-sectional study. JGH Open 2024; 8:e13116. [PMID: 39170058 PMCID: PMC11336044 DOI: 10.1002/jgh3.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 06/07/2024] [Accepted: 06/21/2024] [Indexed: 08/23/2024]
Abstract
Background and Aim Adequate bowel preparation is necessary for optimal colonoscopy. Inadequate bowel preparation results in increased costs and imprecise colonoscopy results. This study aims to determine the incidence and risk factors of inadequate bowel preparation. Methods In this study, 604 consecutive patients were observed prospectively who underwent colonoscopy examination. The patient's clinical and demographic data were obtained on the day of the procedure. Bowel preparation was evaluated by Boston Bowel Preparation Scale (BBPS) and was divided into two groups; adequate and inadequate. Univariate and multivariate analyses were performed. Results Inadequate bowel preparation incidence was 17.9%. In the univariate analysis, education level (P value = 0.009), body mass index (P value = 0.03), admission type (P value = 0.038), previous history of colonoscopy (P value = 0.03), color and consistency of the last feces (P value = 0.03), diabetes (P value = 0.004), and smoking (P value = 0.03) were significantly related with the incidence of inadequate bowel preparation. While ischemic heart disease (IHD) decreased the level of inadequate bowel preparation (P value = 0.047). Multivariate analysis showed that diabetes mellitus (odds ratio [OR] = 2.18), smoking (OR = 2.10), inpatient status of admission type (OR = 3.32), last stool that was non-watery (OR = 1.60), and ischemic heart disease (OR = 0.032) were independent factors associated with inadequate bowel preparation. Conclusion Diabetic patients, smokers, inpatients and who defecated a non-watery and colory stool as the last defecation are at risk of inadequate bowel preparation and need more potent regimens. It is important to inform patients about preventable factors that affect bowel preparation to improve their preparation outcomes.
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Affiliation(s)
- Alireza Asgari
- Digestive Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Fateme Ziamanesh
- Digestive Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Ali Aliasgari
- Digestive Disease Research InstituteTehran University of Medical SciencesTehranIran
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Yan H, Huang H, Yang D, Chen Z, Liu C, Huang Z, Zhao R, Shan J, Yang L, Yang J, Deng K. 3 L split-dose polyethylene glycol is superior to 2 L polyethylene glycol in colonoscopic bowel preparation in relatively high-BMI (≥ 24 kg/m 2) individuals: a multicenter randomized controlled trial. BMC Gastroenterol 2023; 23:427. [PMID: 38053082 PMCID: PMC10698874 DOI: 10.1186/s12876-023-03068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Whether body mass index (BMI) is a risk factor for poor bowel preparation is controversial, and the optimal bowel preparation regimen for people with a high BMI is unclear. METHODS We prospectively included 710 individuals with high BMIs (≥ 24 kg/m2) who were scheduled to undergo colonoscopy from January to November 2021 at 7 hospitals. Participants were randomly allocated into 3 L split-dose polyethylene glycol (PEG) group (n=353) and 2 L PEG group (n=357). The primary outcome was the rate of adequate bowel preparation, and the secondary outcomes included Boston Bowel Preparation Scale (BBPS) score, polyp detection rate, cecal intubation rate, and adverse reactions during bowel preparation. Furthermore, we did exploratory subgroup analyses for adequate bowel preparation. RESULTS After enrollment, 15 individuals didn't undergo colonoscopy, finally 345 participants took 3 L split-dose PEG regimen, and 350 participants took 2 L PEG regimen for colonoscopic bowel preparation. 3 L split-dose PEG regimen was superior to 2 L PEG regimen in the rate of adequate bowel preparation (81.2% vs. 74.9%, P = 0.045), BBPS score (6.71±1.15 vs. 6.37±1.31, P < 0.001), and the rate of polyp detection (62.0% vs. 52.9%, P = 0.015). The cecal intubation rate was similar in both groups (99.7%). Regarding adverse reactions, individuals were more likely to feel nausea in the 3 L PEG group (30.9% vs. 19.3%; P = 0.001); however, the degree was mild. In the subgroup analysis for adequate bowel preparation, 3 L split-dose PEG regimen performed better than 2 L PEG regimen in the overweight (BMI 25-29.9 kg/m2 ) (P = 0.006) and individuals with constipation (P = 0.044), while no significant differences were observed in relatively normal (BMI 24-24.9 kg/m2) (P = 0.593) and obese individuals (BMI ≥ 30 kg/m2) (P = 0.715). CONCLUSIONS 3 L split-dose PEG regimen is superior to 2 L PEG regimen for colonoscopic Bowel Preparation in relatively high-BMI individuals, especially overweight individuals (BMI 25-29.9 kg/m2 ). TRIAL REGISTRATION This trial was registered in the Chinese Clinical Trials Registry (ChiCTR2000039068). The date of first registration, 15/10/2020, http://www.chictr.org.cn.
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Affiliation(s)
- Hailin Yan
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hongyu Huang
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Dailan Yang
- Department of Gastroenterology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zonghua Chen
- Department of Gastroenterology, Yibin Second People's Hospital, Yibin, 644000, Sichuan, China
| | - Chao Liu
- Department of Gastroenterology, Hospital of the Office of the Tibet Autonomous Region People's Government in Chengdu, Chengdu, 610041, Sichuan, China
| | - Zhong Huang
- Division of Gastroenterology, Zigong First People's Hospital, Zigong, 643000, Sichuan, China
| | - Rui Zhao
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Chengdu, 610041, Sichuan, China
- Department of Endoscopy Center, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Chengdu, 610041, Sichuan, China
| | - Jing Shan
- Department of Gastroenterology, The 3rd People's Hospital of Chengdu, Southwest Jiaotong University, Chengdu, 610031, Sichuan, China
| | - Li Yang
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Chengdu, 610041, Sichuan, China
| | - Jinlin Yang
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Chengdu, 610041, Sichuan, China.
| | - Kai Deng
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Chengdu, 610041, Sichuan, China.
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Yao-dong L, Yi-ping W, Gang M, Yang-yun H, Ling-ling Z, Hong D, Jia-zheng D, Rong-chao X, You-wei L, Ming Z, Shun-bin D, Jing L, Yang S, Jia-qi D, Lei D, Xiong-feng S, You-jian Z, Zuo-qiong Z. Comparison of oral sodium phosphate tablets and polyethylene glycol lavage solution for colonoscopy preparation: a systematic review and meta-analysis of randomized clinical trials. Front Med (Lausanne) 2023; 10:1088630. [PMID: 37305114 PMCID: PMC10250678 DOI: 10.3389/fmed.2023.1088630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Objective To systematically compare the bowel cleaning ability, patient tolerance and safety of oral sodium phosphate tablets (NaPTab) and oral polyethylene glycol electrolyte lavage solution (PEGL) to inform clinical decision making. Methods PubMed, Embase, CBM, WanFang Data, CNKI, and VIP databases were searched for studies that used randomized controlled trials (RCTs) to compare the roles of NaPTab and PEGL in bowel preparation before colonoscopy. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias in the included papers. A meta-analysis was performed using RevMan 5.3 software. Results A total of 13 RCTs were eligible for inclusion, including 2,773 patients (1,378 and 1,395 cases in the NaPTab and PEGL groups, respectively). Meta-analysis revealed no significant difference in the cleansing quality of the NaPTab and PEGL groups [RR 1.02, 95% CI (0.96-1.08), P = 0.46]. The incidence of nausea was lower in the NaPTab group than in the PEGL group [RR 0.67, 95% CI (0.58-0.76), p < 0.00001]. Patients rated the taste of NaPTab higher than PEGL [RR 1.33, 95% CI (1.26-1.40), P < 0.00001]. Willingness to repeat the treatment was also higher in the NaPTab group than in the PEGL group [RR 1.52, 95% CI (1.28-1.80), P < 0.00001]. Both serum potassium and serum calcium decreased in both groups after the preparation; however, meta-analysis revealed that both minerals decreased more in the NaPTab group than in the PEGL group [MD = 0.38, 95% CI (0.13-0.62), P = 0.006 for serum potassium and MD = 0.41, 95% CI (0.04-0.77), P = 0.03 for serum calcium]. Meanwhile, serum phosphorus increased in both groups after the preparation; however, levels increased more in the NaPTab group than in the PEGL group [MD 4.51, (95% CI 2.9-6.11), P < 0.00001]. Conclusions While NaP tablets and PEGL were shown to have a similar cleaning effect before colonoscopy, NaP tablets had improved patient tolerance. However, NaP tablets had a strong effect on serum potassium, calcium, and phosphorus levels. For patients with low potassium, low calcium, and renal insufficiency, NaP tablets should be prescribed with caution. For those at high-risk for acute phosphate nephropathy, NaP tablets should be avoided. Given the low number and quality of included studies, these conclusions will require additional verification by large high-quality studies. Systematic review registration 10.37766/inplasy2023.5.0013, identifier: NPLASY202350013.
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Affiliation(s)
- Li Yao-dong
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wang Yi-ping
- West China Hospital, Sichuan University, Chengdu, China
| | - Mai Gang
- Surgical Department of Deyang People's Hospital, Deyang, China
| | - Han Yang-yun
- Surgical Department of Deyang People's Hospital, Deyang, China
| | - Zhu Ling-ling
- West China Hospital, Sichuan University, Chengdu, China
| | - Deng Hong
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Deng Jia-zheng
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Xiang Rong-chao
- Surgical Department of Deyang People's Hospital, Deyang, China
| | - Li You-wei
- Surgical Department of Deyang People's Hospital, Deyang, China
| | - Zhao Ming
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Ding Shun-bin
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Ling Jing
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Shen Yang
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Dong Jia-qi
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Deng Lei
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Song Xiong-feng
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Zhang You-jian
- Gastroenterology Department of Deyang People's Hospital, Deyang, China
| | - Zhou Zuo-qiong
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Campanile FC. The Quality of Bowel Preparation After Bariatric Surgery: Diverse Effects of Diversion. Dig Dis Sci 2022; 67:2701-2702. [PMID: 34669077 DOI: 10.1007/s10620-021-07278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Fabio Cesare Campanile
- Division of General Surgery, ASL Viterbo, San Giovanni Decollato - Andosilla Hospital, 01033, Civita Castellana, Italy.
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Chen G, Zhao Y, Xie F, Shi W, Yang Y, Yang A, Wu D. Educating Outpatients for Bowel Preparation Before Colonoscopy Using Conventional Methods vs Virtual Reality Videos Plus Conventional Methods: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2135576. [PMID: 34807255 PMCID: PMC8609410 DOI: 10.1001/jamanetworkopen.2021.35576] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Adequate bowel preparation is essential for diagnostic, screening, and surveillance colonoscopy. Virtual reality (VR) has the characteristics of immersion, interaction, and imagination and has been widely used in medicine for training and teaching, indicating that it could be used in the education of outpatients for bowel preparation before colonoscopy. OBJECTIVE To investigate whether using VR videos for patient education before colonoscopy could improve bowel preparation. DESIGN, SETTING, AND PARTICIPANTS A prospective, single-blinded, randomized clinical trial of 346 patients undergoing colonoscopy with local anesthesia in a tertiary care hospital was conducted between October 1, 2018, and November 1, 2020. Outpatients who had indications for colonoscopy and had not received one before were enrolled. Statistical analysis was performed from November 1 to December 31, 2020. All data were analyzed according to the intention-to-treat approach. EXPOSURES Conventional bowel preparation education (oral instructions and written materials that had the same contents) or conventional education plus VR videos. MAIN OUTCOMES AND MEASURES The primary outcome was the quality of bowel preparation measured by the Boston Bowel Preparation Scale score (range, 0-9, where 0 indicates extremely unsatisfactory bowel preparation and 9 indicates complete bowel preparation). Secondary outcomes included polyp and adenoma detection rates, compliance with complete bowel cleansing, preprocedure anxiety, overall satisfaction, and willingness to undergo a follow-up colonoscopy. RESULTS A total of 346 outpatients were enrolled in the trial, with 173 patients randomly assigned to each group (control group: 87 women [50.3%]; mean [SD] age, 50.5 [12.5] years; VR video group: 84 women [48.6%]; mean [SD] age, 52.6 [11.4] years). Baseline characteristics, including demographic information, medical history, lifestyle, and the characteristics of stool, were comparable between the VR video group and the control group. The mean (SD) Boston Bowel Preparation Scale score was significantly higher in the VR video group than in the control group (7.61 [1.65] vs 7.04 [1.70]; P = .002). The detection rate of polyps (72 of 172 [41.9%] vs 46 of 172 [26.7%]; P = .003) and the detection rate of adenomas (56 of 172 [32.6%] vs 38 of 172 [22.1%]; P = .03) were also higher in the VR video group. Patients who received VR education had better compliance (119 [68.8%] vs 87 [50.3%]; P < .001) and higher mean (SD) overall satisfaction (8.68 [1.70] vs 8.16 [2.15]; P = .01) with bowel preparation. CONCLUSIONS AND RELEVANCE Patients who received VR video education before colonoscopy had better bowel preparation, higher polyp and adenoma detection rates, and improved compliance and satisfaction. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03667911.
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Affiliation(s)
- Guorong Chen
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Zhao
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital, Beijing, China
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
| | - Wen Shi
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingyun Yang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Aiming Yang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dong Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Abstract
BACKGROUND/AIMS Suboptimal bowel cleansing is common in children and can impact diagnostic and therapeutic outcomes. We aimed to identify risk factors for suboptimal bowel preparation for colonoscopy in pediatric patients. METHODS This was a retrospective study of all patients ages 0 to 21 years who underwent colonoscopy at a children's hospital from 2015 to 2019 in the United States. Demographics and clinical information were obtained from the electronic health record. The primary outcome was suboptimal bowel preparation measured by the endoscopist on a dichotomized Aronchik Scale. Univariate and multivariate regression modeling were used to determine independent predictors of suboptimal preparation. RESULTS Nine hundred and eight patients (mean age 12.17 years [±5.14], boys 465 (51.2%), were included in the analysis. Suboptimal preparation was noted in 242 (26.7%). On univariate analysis, suboptimal preparation was more common in those of younger age (38.6%), Medicaid (32.1%), Spanish as primary language (35.7%), and failure to thrive (FTT) (45.9%). Suboptimal preparations were less common in patients with inflammatory bowel disease (IBD) (11.6%). After adjustment for other covariates, IBD and FTT maintained their statistical associations, IBD (odds ratio [OR] 0.27 95% confidence interval [CI] 0.095-0.75, P = 0.01), FTT (OR 1.98 95% CI 1.28-3.06, P = <0.01). CONCLUSIONS To our knowledge, this is the first investigation of pediatric patients to identify independent risk factors for suboptimal bowel preparation. We confirm Medicaid status and English as a second language as risk factors as well as highlight distinct associations from those reported in the adult literature including FTT and younger age. IBD was associated with optimal cleansing. Future research to understand the mechanisms of inferred risk or potential protection is required.
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Ramprasad C, Ng S, Zhang Y, Liang PS. Low-residue diet for colonoscopy in veterans: Risk factors for inadequate bowel preparation and patient satisfaction and compliance. PLoS One 2020; 15:e0233346. [PMID: 32437378 PMCID: PMC7241790 DOI: 10.1371/journal.pone.0233346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/03/2020] [Indexed: 01/10/2023] Open
Abstract
Bowel preparation with low-residue diet (LRD) has resulted in higher patient satisfaction and similar polyp detection rates compared to conventional clear liquid diet. However, there is limited experience with LRD in veterans, in whom conditions associated with poor bowel preparation are more prevalent than the general population. To examine risk factors associated with inadequate bowel preparation, we conducted a chart review of outpatient colonoscopies at the Manhattan VA Medical Center from February 2017 to April 2018. To examine patient satisfaction and compliance, we administered an anonymous questionnaire to patients undergoing outpatient colonoscopy from March to August 2018. Patients assessed by chart review (n = 660) were 92% male with a mean age of 64 years. An adequate Boston Bowel Preparation Scale score ≥2 in each colonic segment was achieved in 94% of procedures. Higher BMI, diabetes, prior inadequate bowel preparation, bowel preparation duration of two days, and opioid use were associated with inadequate bowel preparation on univariable analysis. On multiple logistic regression, only higher BMI remained a predictor, with every one-unit increase associated with a 6% increased odds of poor bowel preparation. Questionnaire responses showed 84% of patients were willing to repeat LRD bowel preparation, 85% found the process easy or acceptable, and 78% reported full adherence to LRD. These findings demonstrate that bowel preparation quality, patient satisfaction, and compliance were all high among veterans using LRD.
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Affiliation(s)
- Chethan Ramprasad
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - Sandy Ng
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - Yian Zhang
- Division of Biostatistics, Department of Population Health and Environmental Medicine, NYU Langone Health, New York, New York, United States of America
| | - Peter S. Liang
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
- Department of Medicine, VA New York Harbor Health Care System, New York, New York, United States of America
- * E-mail:
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Hookey L, Bertiger G, Johnson KL, Boules M, Ando M, Dahdal DN. Efficacy, safety, and tolerability of a ready-to-drink bowel preparation in overweight and obese adults: subanalysis by body mass index from a phase III, assessor-blinded study. Therap Adv Gastroenterol 2020; 13:1756284820910050. [PMID: 32313553 PMCID: PMC7153178 DOI: 10.1177/1756284820910050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/05/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We performed a post hoc secondary analysis for the effect of body mass index (BMI) on the efficacy, tolerability, and safety of ready-to-drink sodium picosulfate, magnesium oxide, and citric acid (SPMC oral solution) bowel preparation. METHODS A phase III, randomized, assessor-blinded, multicenter, noninferiority study was conducted comparing split-dose, low-volume SPMC oral solution with a powder formulation for oral solution. A post hoc secondary analysis assessed efficacy, safety, and tolerability of SPMC oral solution stratified by BMI. BMI was classified by Centers for Disease Control and Prevention definitions (underweight and normal weight: BMI < 25 kg/m2; overweight: BMI 25-29.9 kg/m2; class I obesity: BMI 30-34.9 kg/m2; class II obesity: BMI 35-39.9 kg/m2; class III/severe obesity: BMI ⩾40 kg/m2). Prespecified primary efficacy endpoint ('responders') was the proportion of participants with 'excellent' or 'good' ratings on a modified Aronchick Scale (AS). Secondary efficacy outcomes were the quality of cleansing of the right colon as assessed by the Boston Bowel Preparation Scale (BBPS); as well as selected findings from the Mayo Clinic Bowel Prep Tolerability Questionnaire. Safety assessments included adverse events (AEs) and laboratory evaluations. RESULTS Between 82.8% and 92.5% of participants in any BMI group were responders by AS, and between 91.3% and 100% were responders by BBPS in the right colon. Efficacy was consistent across BMI groups, with no clear trends. Greater than 83% of participants in any BMI group found the preparation 'easy' or 'acceptable' to ingest, and the majority (>58%) rated SPMC oral solution as 'better' than a prior bowel preparation. In all BMI groups, safety data were similar to the overall cohort. Commonly reported, drug-related, treatment-emergent AEs were, by ascending BMI group, nausea (1.1%, 5.3%, 1.0%, 5.7%, and 0%) and headache (1.1%, 4.1%, 1.0%, 5.7%, and 0%). CONCLUSIONS Ready-to-drink SPMC oral solution had consistent, good quality colon cleansing, and favorable tolerability among participants of all BMI groups. CLINICALTRIALSGOV REGISTRATION NCT03017235.
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Affiliation(s)
- Lawrence Hookey
- Gastrointestinal Disease Research Unit, Department of Medicine, Queen’s University, Kingston, ON, Canada
| | | | | | - Mena Boules
- Ferring Pharmaceuticals, Inc., Parsippany, NJ, USA
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Kapila N, Singh H, Kandragunta K, Castro FJ. Open Access Colonoscopy for Colorectal Cancer Prevention: An Evaluation of Appropriateness and Quality. Dig Dis Sci 2019; 64:2798-2805. [PMID: 30955174 DOI: 10.1007/s10620-019-05612-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/02/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Open access colonoscopy (OAC) has gained widespread acceptance and has the potential to increase colorectal cancer (CRC) screening. However, there is little data evaluating its appropriateness for CRC prevention. AIMS The aim of this study is to evaluate the appropriateness of OAC in CRC screening and polyp surveillance by comparing to procedures ordered by gastroenterologists (NOAC). As secondary outcomes, we compared the quality of bowel preparation and adenoma detection rate (ADR) between OAC and NOAC. METHODS It is retrospective single-center study. Inclusion criteria included patients > 50 years of age undergoing a colonoscopy for CRC screening and surveillance. Appropriateness was defined as those colonoscopies performed within 12 months of the recommended 2012 consensus guidelines. Secondary outcomes included the quality of bowel preparation and ADR. RESULTS 5211 colonoscopies met inclusion criteria, and 64.9% were OAC. Screening OAC was appropriately 91.6% and NOAC 92.9% of the time (p = 0.179). Surveillance NOAC were inappropriate in 26.4% of cases, and surveillance OAC was 32.6% (p = 0.008). Multivariate analysis demonstrated that OAC did not influence ADR (OR for NOAC 0.97; 95% CI 0.86-1.1; p = 0.644) or an adequate bowel preparation (OR for NOAC 1.11; 95% CI 0.91-1.36; p = 0.306). CONCLUSION OAC performed similarly to NOAC for screening indications, quality of bowel preparation, and ADR. However, more surveillance procedures were inappropriate in the OAC group although both groups had a high number of inappropriate indications. Although OAC can be efficiently performed for screening indications, measures to decrease inappropriate surveillance colonoscopies are needed.
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Affiliation(s)
- Nikhil Kapila
- Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, USA.
| | - Harjinder Singh
- Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, USA
| | - Kiranmayee Kandragunta
- Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, USA
| | - Fernando J Castro
- Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, USA
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