Division of Gastroenterology, Western University, London, Ontario, Canada; Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada.
Division of Gastroenterology, University of Montreal, Montreal, Quebec, Canada.
Clin Gastroenterol Hepatol. 2022 Jun;20(6):e1283-e1291. doi: 10.1016/j.cgh.2021.07.015. Epub 2021 Jul 10.
BACKGROUND & AIMS: Failed bowel preparation for colonoscopy occurs commonly, but the optimal regimen for the subsequent attempt is unknown. High-volume preparations often are used but are not well studied. The objective of this study was to compare the efficacy, tolerability, and safety of 2 regimens for use after failed bowel preparation.
A multicenter, endoscopist-blinded randomized controlled trial was conducted in patients who previously failed bowel preparation despite adequate compliance. Patients were randomized to 1 of 2 split polyethylene glycol (PEG) regimens, preceded by 15 mg bisacodyl: PEG 2 L the evening before and 2 L the day of colonoscopy (PEG 2+2L+bisacodyl), or 4 L and 2 L (PEG 4+2L+bisacodyl). All patients followed a low-fiber diet on both the third and second day before the procedure, followed by a clear fluid diet the day before and the morning of the colonoscopy. The primary outcome was adequate bowel preparation, defined as a Boston Bowel Preparation Scale total score of 6 or higher, with all segment scores of 2 or higher. Secondary outcomes included adenoma detection rate, advanced adenoma detection rate, sessile serrated lesion detection, cecal intubation rate, tolerability, and adverse events.
A total of 196 subjects were randomized at 4 academic centers in Canada (mean age, 60.7 y; SD, 11.4 y; 44.9% were women). There were no significant differences between the PEG 2+2L+bisacodyl and the PEG 4+2L+bisacodyl groups in achieving adequate bowel preparation (91.2% vs 87.6%; P = .44). There were no significant differences with regard to mean adenoma detection rate (37.4% vs 31.5%; P = .41), advanced adenoma detection rate (18.7% vs 11.2%; P = .16), sessile serrated lesion detection (8.8% vs 5.6%; P = .41), and cecal intubation rate (96.7% vs 92.1%; P = .19). The 2 regimens were similarly well tolerated, but PEG 2+2L+bisacodyl was associated with a higher willingness to repeat the bowel preparation (91.2% vs 66.2%; P < .001).
Split-dose 4 L-PEG with 15 mg bisacodyl, along with dietary restrictions, has similar efficacy as a higher-volume preparation, and should be considered for patients who previously failed bowel preparation (ClinicalTrials.gov number, NCT02976805).
结肠镜检查中常出现肠道准备失败，但后续尝试的最佳方案尚不清楚。大容量制剂通常被使用，但尚未得到充分研究。本研究旨在比较两种方案在肠道准备失败后的疗效、耐受性和安全性。
这是一项多中心、内镜医师设盲、随机对照临床试验，纳入了既往肠道准备充分但仍失败的患者。患者被随机分为 2 组，分别接受以下 2 种聚乙二醇（PEG）方案：PEG 2 L 于前一天晚上和结肠镜检查当天服用（PEG 2+2L+bisacodyl），或 4 L 和 2 L（PEG 4+2L+bisacodyl）。所有患者在检查前第 3 天和第 2 天遵循低纤维饮食，然后在检查前 1 天和结肠镜检查当天上午遵循清淡液体饮食。主要结局为肠道准备充分，定义为波士顿肠道准备量表总分达到 6 分或以上，所有节段评分均达到 2 分或以上。次要结局包括腺瘤检出率、高级别腺瘤检出率、平坦型锯齿状病变检出率、盲肠插管率、耐受性和不良事件。
在加拿大的 4 个学术中心共纳入 196 例患者（平均年龄 60.7 岁，标准差 11.4 岁；44.9%为女性）。PEG 2+2L+bisacodyl 组和 PEG 4+2L+bisacodyl 组在实现肠道准备充分方面无显著差异（91.2% vs 87.6%；P=0.44）。两组的平均腺瘤检出率（37.4% vs 31.5%；P=0.41）、高级别腺瘤检出率（18.7% vs 11.2%；P=0.16）、平坦型锯齿状病变检出率（8.8% vs 5.6%；P=0.41）和盲肠插管率（96.7% vs 92.1%；P=0.19）均无显著差异。两种方案的耐受性相似，但 PEG 2+2L+bisacodyl 组更愿意重复肠道准备（91.2% vs 66.2%；P<0.001）。
PEG 2+2L+bisacodyl 与饮食限制联合使用的分剂量 4 L-PEG 方案与大容量制剂疗效相当，对于肠道准备失败的患者应考虑使用（ClinicalTrials.gov 编号：NCT02976805）。
