Department of Internal Medicine and Gastrointestinal Cancer Center, Division of Gastroenterology.
Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul.
J Clin Gastroenterol. 2019 Sep;53(8):e308-e315. doi: 10.1097/MCG.0000000000001087.
The goal of this study was to evaluate the noninferiority of colonoscopic enema to additional oral preparation in salvage bowel cleansing for inadequate preparation for a morning colonoscopy.
Colonoscopic enema, administering additional cathartics into the right colon through the colonoscope accessory channel, is suggested to rescue poor bowel preparation for a colonoscopy but lacking comparative study.
In this prospective, randomized, actively-controlled, parallel group, noninferiority trial, consecutive outpatients and health checkup recipients aged from 19 to 70 years with inappropriate bowel preparation during an elective colonoscopy were enrolled to receive either a colonoscopic enema of 1 L polyethylene glycol (PEG) (enema group) or additional oral intake of 2 L PEG (oral group). The primary endpoint was the proportion of adequate bowel preparation evaluated using the Boston Bowel Preparation Scale.
Overall, 131 participants were randomized. Adequate bowel preparation was achieved in 53% (35/66) of the enema group, which was significantly inferior to the oral group (81.5%; 53/67) with a difference of -28.5% (95% confidence interval, -44.1, -12.9; P=0.001). The largest difference in the proportion of adequate bowel preparation was observed in the right colon (57.8% in the enema group vs. 86.9% in the oral group; P<0.001), followed by the transverse colon (85.9% vs. 98.4%; P=0.017) and the left colon (90.6% vs. 96.7%; P=0.274).
The colonoscopic enema of 1 L PEG was inferior to the additional oral ingestion of 2 L PEG regarding efficacy as a salvage bowel preparation in adults with inadequate bowel cleansing for colonoscopy.
本研究旨在评估结肠镜灌肠在补救因结肠镜检查前肠道准备不足而导致的肠道清洁不佳方面不劣于额外口服准备。
通过结肠镜附件通道向右结肠内注入额外的泻药以补救结肠镜检查时肠道准备不佳的情况，但缺乏相关对比研究。
在这项前瞻性、随机、主动对照、平行组非劣效性试验中，连续招募了年龄在 19 岁至 70 岁之间的因择期结肠镜检查而肠道准备不充分的门诊患者和健康检查受检者，他们将接受 1L 聚乙二醇（PEG）的结肠镜灌肠（灌肠组）或额外口服 2L PEG（口服组）。主要终点是使用波士顿肠道准备量表评估的充分肠道准备比例。
共有 131 名参与者被随机分配。灌肠组中 53%（35/66）的患者达到了充分的肠道准备，显著低于口服组的 81.5%（53/67），差异为-28.5%（95%置信区间，-44.1，-12.9；P=0.001）。在右半结肠（灌肠组 57.8%，口服组 86.9%；P<0.001）、横结肠（85.9% vs. 98.4%；P=0.017）和降结肠（90.6% vs. 96.7%；P=0.274）中，充分肠道准备的比例差异最大。
对于因结肠镜检查前肠道清洁不佳而需要补救肠道准备的成年人，1L PEG 的结肠镜灌肠在疗效方面劣于额外口服 2L PEG。
