Sacks Naomi C, Sharma Abhishek, Cyr Philip L, Bertiger Gerald, Dahdal David N, Brogadir Stuart P
Precision Xtract, Boston, MA, USA.
Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
Clin Exp Gastroenterol. 2018 Aug 16;11:289-299. doi: 10.2147/CEG.S171861. eCollection 2018.
Proper bowel cleansing is necessary prior to colonoscopy, but poor tolerability to bowel preparation agents may increase the odds of poor cleansing and incomplete screenings. The aim of this study was to evaluate the real-world effectiveness and safety of bowel preparation agents.
Claims data were extracted for individuals who had a screening colonoscopy from July 1, 2012, to June 30, 2015, were ≥18 years of age, and who could be observed ≥6 months before and ≥3 months after the screening. Data were stratified by agent class, including over-the-counter (OTC), low-volume (LV), and high-volume (HV) agents. Rates of incomplete screenings, repeat screenings, and hospitalizations were reported. Multivariate logistic regression was conducted to compare outcomes for sodium picosulfate, magnesium oxide, and citric acid (P/MC) vs other agents.
Of 2.8 million individuals, 71.5% were average risk and 28.5% were high risk for colorectal cancer. Rates of use were 2.8% for P/MC, 30.1% for other LV agents, 9.4% for HV agents, and 56.6% for OTC agents. All individuals who used P/MC had significantly lower odds of incomplete screenings compared to those who used other LV agents or HV agents (<0.05). In average-risk patients, rates of 30- and 90-day repeat screenings were highest for the P/MC group (16.7% and 23.0%, respectively) compared to other agents. Across all patient analysis groups, the rates of hospitalizations for hyponatremia or dehydration were much higher for those who used an OTC bowel preparation agent compared to those who used LV or HV agents, or P/MC.
P/MC was associated with lower rates of incomplete colonoscopy and higher rates of repeat screenings, suggesting it was better tolerated than other agents. OTC agents were associated with higher rates of hospitalizations.
结肠镜检查前进行适当的肠道清洁是必要的，但对肠道准备剂的耐受性差可能会增加清洁效果不佳和筛查不完整的几率。本研究的目的是评估肠道准备剂在现实世界中的有效性和安全性。
提取2012年7月1日至2015年6月30日期间进行筛查结肠镜检查、年龄≥18岁且在筛查前≥6个月和筛查后≥3个月可观察的个体的索赔数据。数据按制剂类别分层，包括非处方药（OTC）、低容量（LV）和高容量（HV）制剂。报告了筛查不完整、重复筛查和住院率。进行多变量逻辑回归以比较比沙可啶、氧化镁和柠檬酸（P/MC）与其他制剂的结果。
在280万个体中，71.5%为平均风险，28.5%为结直肠癌高风险。P/MC的使用率为2.8%，其他LV制剂为30.1%，HV制剂为9.4%，OTC制剂为56.6%。与使用其他LV制剂或HV制剂的个体相比，所有使用P/MC的个体筛查不完整的几率显著更低（<0.05）。在平均风险患者中，与其他制剂相比，P/MC组30天和90天重复筛查率最高（分别为16.7%和23.0%）。在所有患者分析组中，使用OTC肠道准备剂的个体发生低钠血症或脱水的住院率远高于使用LV或HV制剂或P/MC的个体。
P/MC与较低的结肠镜检查不完整率和较高的重复筛查率相关，表明其耐受性优于其他制剂。OTC制剂与较高的住院率相关。
