BACKGROUND AND AIMS - Adequate colonic examination is strictly associated with optimal bowel preparation. Split-dose polyethylene glycol (PEG) based bowel preparation is considered the gold standard. Inpatients are high-risk patients for poor bowel cleansing and often need a correct diagnosis in the shortest time. The rate of inadequate inpatient bowel preparation is high and associated with a significant increase in hospital length of stay and costs.
The aim of this study is to test the efficacy and tolerability of a new same-day low dose, 1 liter, PEG based bowel preparation in hospitalized selected patients.
METHODS - A single-center prospective, double-blind, study is proposed including hospitalized patients scheduled to colonoscopy, presenting risk factors for poor bowel preparation, such as bleeding and/or subocclusive symptoms, in which inflammatory or neoplastic stenosis is suspected. All included patients are randomly divided in two groups receiving: 1L PEG-based on the same day or 4L PEG split-dose, performing colonoscopy within 4 hours after the last dose. Patient demographics, medical history and Bristol Stool Scale type are acquired. After the examination endoscopic data as caecal intubation, withdrawal time, adenoma detection rate and quality of colonic preparation, assessed by the Boston bowel preparation scale (BBPS), are also recorded. The diagnostic rate, is defined as the number of patients with a valid diagnosis after colonoscopy prepared by these two different protocols.
CONCLUSION - We already collected preliminary promising results in a pilot study including 44 selected inpatients. Our preliminary data support that this schedule protocol allows a correct diagnosis in most of selected patients in a shortest time. Therefore this protocol could be introduced in hospitalized high-risk patients in order to improve tolerability and to reduce the waiting time and the length of stay but more studies with a greater number of patients are required.
In clinical practice, patients experience problems completing the preparation because of the large volume and the salty taste of the solution, and they tend to drink less than the full required amount, resulting in suboptimal efficacy.
Furthermore, has been previously shown that the inadequate preparations are associated with longer hospital lengths of stay and hospital costs compared to adequate preparations. In a recent study, patients with an inadequate preparations had, on average, a 25 % longer length of stay compared to patients with an adequate preparation. Similarly, hospital costs for patients with an inadequate preparation were 1.3 times greater on average compared to those with adequate preparations.
We think that the same-day, low dose, 1-L PEG-based bowel preparation could be introduced in selected inpatients to improve tolerability and to reduce the waiting time and the length of stay.
In the preliminary results of our pilot study, that were presented at national and international congresses, no statistical differences were evident between the two groups in terms of diagnostic rate and successful bowel cleansing achieved. However, the promising results obtained in the pilot study, require a greater number of patients for an objective and accurate evaluation, which would allow this preparation protocol to be proposed in clinical practice for selected high-risk inpatients.