3 liters of polyethylene glycol vs. standard bowel preparation have equal efficacy in a Chinese population: a randomized, controlled trial

Abstract

Background: The European Society of Gastrointestinal Endoscopy recommends 4L Polyethylene Glycol (PEG) as the standard regimen for bowel preparation (BP). The current study compared 3L and 4L PEG with regard to their effectiveness, tolerability, and safety among Chinese patients to identify the best bowel cleansing method for this population.

Methods: The study employed a prospective, observer-blinded, randomized and controlled design in a high-volume endoscopic center. Consecutive patients undergoing colonoscopy were randomly assigned (1:1) to the 3L-PEG or 4L-PEG group. The quality of bowel cleansing, procedure time, adenoma detection rate (ADR), patient tolerance, and adverse events were compared.

Results: A total of 330 patients were included in the study. After exclusions, 160 cases in the 3L-PEG group and 158 cases in the 4L-PEG group were included in the final analysis. The quality of bowel cleansing (Boston Bowel Preparation Scale) for both the whole intestine and each segment had no significant differences between the groups (P > 0.05). No significant differences were found with regard to procedure time or ADR. The incidences of adverse events such as nausea (P = 0.001), vomiting (P = 0.002), and bloating (P < 0.001) were lower in the 3L-PEG group. Moreover, there was a higher rate of satisfaction in the 3L-PEG group than in the 4L-PEG group (P = 0.009).

Conclusions: 3L-PEG bowel cleansing represents an optimal alternative to a 4L-PEG preparation, showing similar efficacy and superior levels of satisfaction, acceptability, and safety among users. We recommend 3L PEG as a routine regimen in the clinical setting for Chinese patients. (ClinicalTrials.gov registration number: NCT03356015, registered in 29 November, 2017, https://www.

Clinicaltrials: gov/ct2/show/NCT03356015).

Keywords: PEG; colonoscopy; quality of bowel preparation; tolerability.

Conflict of interest statement

None.

AJTR Copyright © 2022.

Figures

Figure 1

Study flow diagram. PEG, Polyethylene glycol.

Figure 2

Subgroup analyses of adequate bowel cleansing. The effects of 4L-PEG and 3L-PEG regime on adequacy of bowel preparation were analyzed by subgroups. Stratification factors included age, BMI, gender, smoking, drinking, comorbidities, constipation, previous abdominal or pelvic surgery, and prior history of colonoscopy. BMI, Body mass index; OR, Odds ratio; CI, Confidence interval.