Leonardo Frazzoni1, Cristiano Spada2, Franco Radaelli3, Alessandro Mussetto4, Liboria Laterza1, Marina La Marca1, Stefania Piccirelli5, Fabio Cortellini4, Emanuele Rondonotti3, Valentina Paci1, Franco Bazzoli1, Carlo Fabbri6, Mauro Manno7, Giovanni Aragona8, Gianpiero Manes9, Pietro Occhipinti10, Sergio Cadoni11, Rocco Maurizio Zagari1, Cesare Hassan12, Lorenzo Fuccio13. 1. Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy. 2. Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy; Università Cattolica del Sacro Cuore, Rome, Italy. 3. Gastroenterology Unit, Valduce Hospital, Como, Italy. 4. Gastroenterology Unit, S. Maria delle Croci Hospital, Ravenna, Italy. 5. Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy. 6. Unit of Gastroenterology and Digestive Endoscopy, Forli-Cesena Hospital, AUSL Romagna, Forli-Cesena, Italy. 7. UOSD Gastroenterologia ed Endoscopia Digestiva, Azienda USL di Modena, Italy. 8. Department of Internal Medicine, Gastroenterology and Hepatology Unit, "Guglielmo da Saliceto" Hospital, Via Taverna 49, Piacenza, Italy. 9. Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate Milanese Hospital, Milan, Italy. 10. Gastroenterology and Digestive Endoscopy Unit, Ospedale Maggiore della Carità, Novara, Italy. 11. Digestive Endoscopy Unit, Centro Traumatologico-Ortopedico Hospital, Iglesias, Italy. 12. Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy. 13. Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy. Electronic address: lorenzo.fuccio3@unibo.it.
Abstract
BACKGROUND: Inpatients are at risk for inadequate colon cleansing. Experts recommend 4L-polyethylene-glycol (PEG) solution. A higher colon cleansing adequacy rate for a hyperosmolar 1L-PEG plus ascorbate prep has been recently reported. AIMS: We aimed to determine whether 1L-PEG outperforms 4L-PEG among inpatients. METHODS: post-hoc analysis of a large Italian multicenter prospective observational study among inpatients (QIPS study). We performed a propensity score matching between 1L-PEG and 4L-PEG group. The primary outcome was the rate of adequate colon cleansing as assessed by unblinded endoscopists through Boston scale. Secondary outcome was the safety profile. RESULTS: Among 1,004 patients undergoing colonoscopy, 724 (72%) were prescribed 4L-PEG and 280 (28%) 1L-PEG. The overall adequate colon cleansing rate was 69.2% (n = 695). We matched 274 pairs of patients with similar distribution of confounders. The rate of patients with adequate colon cleansing was higher in 1L-PEG than in 4L-PEG group (84.3% vs. 77.4%, p = 0.039). No different shift in serum concentration of electrolytes (namely Na+, K+, Ca2+), creatinine and hematocrit were observed for both preparations. CONCLUSION: We found a higher rate of adequate colon cleansing for colonoscopy with the 1L-PEG bowel prep vs. 4L-PEG, with apparent similar safety profile, among inpatients. A confirmatory randomized trial is needed. (ClinicalTrials.gov no: NCT04310332).
BACKGROUND: Inpatients are at risk for inadequate colon cleansing. Experts recommend 4L-polyethylene-glycol (PEG) solution. A higher colon cleansing adequacy rate for a hyperosmolar 1L-PEG plus ascorbate prep has been recently reported. AIMS: We aimed to determine whether 1L-PEG outperforms 4L-PEG among inpatients. METHODS: post-hoc analysis of a large Italian multicenter prospective observational study among inpatients (QIPS study). We performed a propensity score matching between 1L-PEG and 4L-PEG group. The primary outcome was the rate of adequate colon cleansing as assessed by unblinded endoscopists through Boston scale. Secondary outcome was the safety profile. RESULTS: Among 1,004 patients undergoing colonoscopy, 724 (72%) were prescribed 4L-PEG and 280 (28%) 1L-PEG. The overall adequate colon cleansing rate was 69.2% (n = 695). We matched 274 pairs of patients with similar distribution of confounders. The rate of patients with adequate colon cleansing was higher in 1L-PEG than in 4L-PEG group (84.3% vs. 77.4%, p = 0.039). No different shift in serum concentration of electrolytes (namely Na+, K+, Ca2+), creatinine and hematocrit were observed for both preparations. CONCLUSION: We found a higher rate of adequate colon cleansing for colonoscopy with the 1L-PEG bowel prep vs. 4L-PEG, with apparent similar safety profile, among inpatients. A confirmatory randomized trial is needed. (ClinicalTrials.gov no: NCT04310332).
Authors: Jonathan Manning; Juha Halonen; Sandra Jose Cheriyamkunnel; Marco Antonio Álvarez-González Journal: BMC Gastroenterol Date: 2022-01-25 Impact factor: 3.067
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