He Yu, Liu Qi, Chen Yi-Wen, Cui Li-Jian, Cao Kai, Guo Zi-Hao
Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Department of Gastroenterology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
World J Gastrointest Endosc. 2024 Jan 16;16(1):18-28. doi: 10.4253/wjge.v16.i1.18.
The incidence and mortality rate of colorectal cancer progressively increase with age and become particularly prominent after the age of 50 years. Therefore, the population that is ≥ 50 years in age requires long-term and regular colonoscopies. Uncomfortable bowel preparation is the main reason preventing patients from undergoing regular colonoscopies. The standard bowel preparation regimen of 4-L polyethylene glycol (PEG) is effective but poorly tolerated.
To investigate an effective and comfortable bowel preparation regimen for hospitalized patients ≥ 50 years in age.
Patients were randomly assigned to group 1 (2-L PEG + 30-mL lactulose + a low-residue diet) or group 2 (4-L PEG). Adequate bowel preparation was defined as a Boston bowel preparation scale (BBPS) score of ≥ 6, with a score of ≥ 2 for each segment. Non-inferiority was prespecified with a margin of 10%. Additionally, the degree of comfort was assessed based on the comfort questionnaire.
The proportion of patients with a BBPS score of ≥ 6 in group 1 was not significantly different from that in group 2, as demonstrated by intention-to-treat (91.2% 91.0%, 0.953) and per-protocol (91.8% 91.0%, 0.802) analyses. Furthermore, in patients ≥ 75 years in age, the proportion of BBPS scores of ≥ 6 in group 1 was not significantly different from that in group 2 (90.9% 97.0%, 0.716). Group 1 had higher comfort scores (8.85 ± 1.162 7.59 ± 1.735, 0.001), longer sleep duration (6.86 ± 1.204 h 5.80 ± 1.730 h, 0.001), and fewer awakenings (1.42 ± 1.183 2.04 ± 1.835, 0.026) than group 2.
For hospitalized patients ≥ 50 years in age, the bowel preparation regimen comprising 2-L PEG + 30-mL lactulose + a low-residue diet produced a cleanse that was as effective as the 4-L PEG regimen and even provided better comfort.
结直肠癌的发病率和死亡率随年龄增长而逐渐上升，在50岁以后尤为显著。因此，年龄≥50岁的人群需要长期定期进行结肠镜检查。肠道准备不适是阻碍患者定期接受结肠镜检查的主要原因。4升聚乙二醇（PEG）的标准肠道准备方案有效，但耐受性较差。
研究一种针对年龄≥50岁住院患者的有效且舒适的肠道准备方案。
将患者随机分为1组（2升PEG + 30毫升乳果糖 + 低渣饮食）或2组（4升PEG）。充分的肠道准备定义为波士顿肠道准备量表（BBPS）评分≥6分，各节段评分≥2分。预先设定非劣效性界限为10%。此外，根据舒适度问卷评估舒适度。
意向性分析（91.2%对91.0%，P = 0.953）和符合方案分析（91.8%对91.0%，P = 0.802）显示，1组BBPS评分≥6分的患者比例与2组无显著差异。此外，在年龄≥75岁的患者中，1组BBPS评分≥6分的比例与2组无显著差异（90.9%对97.0%，P = （此处原文有误，应为P = 0.716）0.716）。1组的舒适度评分（8.85±1.162对7.59±1.735，P = 0.001）、睡眠时间（6.86±1.204小时对5.80±1.730小时，P = 0.001）高于2组，觉醒次数（1.42±1.183对2.04±1.835，P = 0.026）少于2组。
对于年龄≥50岁的住院患者，2升PEG + 30毫升乳果糖 + 低渣饮食的肠道准备方案产生的清洁效果与4升PEG方案一样有效，甚至舒适度更高
