C Briot1, P Faure2, A L Parmentier3, M Nachury4, C Trang5, S Viennot6, R Altwegg7, P Bulois8, L Thomassin9, M Serrero10, P Ah-Soune11, C Gilletta12, L Plastaras13, M Simon14, X Dray15, L Caillo16, E Del Tedesco17, V Abitbol18, C Zallot19, T Degand20, V Rossi21, G Bonnaud22, D Colin23, B Morel24, B Winkfield25, J B Danset26, J Filippi27, A Amiot28, A Attar29, J Levy30, L Peyrin-Biroulet19, L Vuitton1. 1. Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France. 2. Department of Gastroenterology, Clinique Pasteur, Toulouse, France. 3. Centre de Méthodologie Clinique, University Hospital of Besançon, Besançon, France. 4. Gastroenterology Department, University Hospital of Lille, Lille, France. 5. Department of Hepatology and Gastroenterology, University Hospital Hotel Dieu, Nantes, France. 6. Gastroenterology Department, University Hospital of Caen, Caen, France. 7. Department of Hepatology and Gastroenterology, University Hospital of St Eloi, Montpellier, France. 8. Department of Gastroenterology, Hôpital Privé la Louvière, Ramsay Générale de Santé, Lille, France. 9. Department of Gastroenterology, University Hospital Charles Nicolle, Rouen, France. 10. Department of Gastroenterology, APHM, Hopital Nord, Marseille, France. 11. Department of Hepatology and Gastroenterology, Toulon - La Seyne-sur-Mer Hospital, Toulon, France. 12. Department of Gastroenterology, University Hospital Rangueuil, Toulouse, France. 13. Department of Hepato-Gastroenterology, Hospital Pasteur, Colmar, France. 14. Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France. 15. Department of Gastroenterology, Sorbonne University & APHP, Hôpital Saint-Antoine, Paris, France. 16. Department of Gastroenterology and Hepatology, University Hospital Caremeau, Nimes, France. 17. Department of Gastroenterology, University Hospital of Saint-Etienne, Saint Priest en Jarez, France. 18. Department of Gastroenterology, University Hospital Cochin, Paris, France. 19. Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France. 20. Department of Gastroenterology, University Hospital Le Bocage, Dijon, France. 21. Department of Gastroenterology, Hospital Haut Anjou, Château Gontier, France. 22. Clinique Ambroise Paré, Toulouse, France. 23. Department of Gastroenterology, Clinique de la Miotte, Belfort, France. 24. Department of Gastroenterology, Centre Hospitalier de Villefranche-sur-Saône, Gleizé, France. 25. Department of Hepatology and Gastroenterology, Hôpital Nord Franche-Comté, Trevenans, France. 26. Department of HepatoGastroenterology, European Georges-Pompidou Hospital, APHP, Paris, France. 27. Department of Gastroenterology, University Hospital L'Archet, Nice, France. 28. Department of Gastroenterology, Henri Mondor Hospital, APHP, Creteil, France. 29. Gastroenterology Department, Beaujon University Hospital, Clichy, France. 30. Department of Gastroenterology, Clinique des Cèdres, Cornebarrieu, France.
Abstract
BACKGROUND: Standard high-volume polyethylene glycol [PEG] bowel preparations [PEG-4L] are recommended for patients with inflammatory bowel disease [IBD] undergoing colonoscopy. However, low-volume preparations [≤2 L of active volume] are often used in clinical practice. The aim of this study was to evaluate the efficacy, tolerability, and safety of the various bowel preparations for patients with IBD, including low-volume preparations. METHODS: We conducted a French prospective multicentre observational study over a period of 1 month. Patients aged 18-75 years with IBD with an indication of colonoscopy independent of the study were enrolled. The choice of the preparation was left to the investigators, as per their usual protocol. The patients' characteristics, disease, and colonoscopy characteristics were recorded, and they were given self-reported questionnaires. RESULTS: Twenty-five public and private hospitals enrolled 278 patients. Among them, 46 had a disease flare and 41 had bowel stenoses. Bowel preparations for colonoscopy were as follows: 42% received PEG-2L, 29% received sodium picosulfate [Pico], 15% received PEG-4L, and 14% had other preparations. The preparation did not reach the Boston's score efficacy outcome in the PEG-4L group in 51.2% of the patients [p = 0.0011]. The preparation intake was complete for 59.5% in the PEG-4L group, compared with 82.9% in the PEG-2L group and 93.8% in the Pico group [p < 0.0001]. Tolerability, as assessed by the patients' VAS, was significantly better for both Pico and PEG-2L compared with PEG-4L, and better for Pico compared with PEG-2L [p = 0.008; p = 0.0003]. In multivariate analyses, low-volume preparations were independent factors of efficacy and tolerability. Adverse events occurred in 4.3% of the patients. CONCLUSIONS: Preparations with PEG-2L and Pico were equally safe, with better efficacy and tolerability outcomes compared with PEG-4L preparations. The best efficacy/tolerance/safety profile was achieved with the Pico preparation.
BACKGROUND: Standard high-volume polyethylene glycol [PEG] bowel preparations [PEG-4L] are recommended for patients with inflammatory bowel disease [IBD] undergoing colonoscopy. However, low-volume preparations [≤2 L of active volume] are often used in clinical practice. The aim of this study was to evaluate the efficacy, tolerability, and safety of the various bowel preparations for patients with IBD, including low-volume preparations. METHODS: We conducted a French prospective multicentre observational study over a period of 1 month. Patients aged 18-75 years with IBD with an indication of colonoscopy independent of the study were enrolled. The choice of the preparation was left to the investigators, as per their usual protocol. The patients' characteristics, disease, and colonoscopy characteristics were recorded, and they were given self-reported questionnaires. RESULTS: Twenty-five public and private hospitals enrolled 278 patients. Among them, 46 had a disease flare and 41 had bowel stenoses. Bowel preparations for colonoscopy were as follows: 42% received PEG-2L, 29% received sodium picosulfate [Pico], 15% received PEG-4L, and 14% had other preparations. The preparation did not reach the Boston's score efficacy outcome in the PEG-4L group in 51.2% of the patients [p = 0.0011]. The preparation intake was complete for 59.5% in the PEG-4L group, compared with 82.9% in the PEG-2L group and 93.8% in the Pico group [p < 0.0001]. Tolerability, as assessed by the patients' VAS, was significantly better for both Pico and PEG-2L compared with PEG-4L, and better for Pico compared with PEG-2L [p = 0.008; p = 0.0003]. In multivariate analyses, low-volume preparations were independent factors of efficacy and tolerability. Adverse events occurred in 4.3% of the patients. CONCLUSIONS: Preparations with PEG-2L and Pico were equally safe, with better efficacy and tolerability outcomes compared with PEG-4L preparations. The best efficacy/tolerance/safety profile was achieved with the Pico preparation.