Manes Gianpiero, Fontana Paola, de Nucci Germana, Radaelli Franco, Hassan Cesare, Ardizzone Sandro
*Department of Gastroenterology, G. Salvini Hospital, Garbagnate Milanese, Milano, Italy; †Department of Gastroenterology, L. Sacco University Hospital, Milano, Italy; ‡Department of Gastroenterology, Valduce Hospital, Como, Italy; and §Department of Gastroenterology, Nuovo Regina Margherita Hospital, Roma, Italy.
Inflamm Bowel Dis. 2015 Sep;21(9):2137-44. doi: 10.1097/MIB.0000000000000463.
Low-volume preparations are gaining attention for higher acceptability but have been never evaluated in IBD. We compare the efficacy, safety, and tolerability of a 2-L PEG with a 4-L PEG solution in patients with ulcerative colitis.
This is a multicenter, randomized, single-blind study. Adult outpatients with ulcerative colitis undergoing colonoscopy received either 2-L PEG plus bisacodyl or 4-L PEG. Bowel cleansing was assessed using the Ottawa Scale and rated as adequate if the score was ≤2 in each colon segment. Patient acceptance, satisfaction, and related symptoms were recorded.
Preparation was adequate in 80% of the 211 patients without any differences between groups. Mean Ottawa scores for whole and right colon were similar in the 2 groups. As concern tolerability, 83% patients in 2-L PEG arm and 44.8% in 4-L PEG arm reported no or mild discomfort (P < 0.0001) and 94.3% and 61.9% expressed their willingness to repeat the preparation (P < 0.001). Palatability was better with 2-L PEG, whereas related symptoms occurred more frequently with 4-L PEG. Regardless of preparation, split dosage was associated with better cleansing. Further predictors of poor cleansing were moderate/severe discomfort during preparation and more than 6 hours between end of preparation and colonoscopy. Extension and severity of colitis did not influence quality of preparation.
Low-volume PEG is not inferior to 4-L PEG for bowel cleansing in ulcerative colitis, but it is better tolerated and accepted. The time interval from solution intake and colonoscopy is the most important factor affecting quality of cleansing in ulcerative colitis.
低容量制剂因其更高的可接受性而受到关注，但从未在炎症性肠病中进行过评估。我们比较了2升聚乙二醇（PEG）溶液与4升PEG溶液在溃疡性结肠炎患者中的疗效、安全性和耐受性。
这是一项多中心、随机、单盲研究。接受结肠镜检查的成年溃疡性结肠炎门诊患者接受2升PEG加比沙可啶或4升PEG。使用渥太华量表评估肠道清洁情况，若每个结肠段的评分≤2，则评定为清洁充分。记录患者的接受度、满意度及相关症状。
211例患者中有80%的肠道准备充分，两组之间无差异。两组全结肠和右半结肠的平均渥太华评分相似。在耐受性方面，2升PEG组83%的患者和4升PEG组44.8%的患者报告无不适或仅有轻微不适（P<0.0001），94.3%和61.9%的患者表示愿意再次接受该准备方案（P<0.001）。2升PEG的口感更好，而4升PEG相关症状出现得更频繁。无论采用哪种准备方案，分次给药与更好的清洁效果相关。准备过程中中度/重度不适以及准备结束至结肠镜检查间隔超过6小时是清洁效果不佳的进一步预测因素。结肠炎的范围和严重程度不影响准备质量。
在溃疡性结肠炎的肠道清洁方面，低容量PEG并不逊于4升PEG，但耐受性和接受度更好。从摄入溶液到结肠镜检查的时间间隔是影响溃疡性结肠炎清洁质量的最重要因素。
