In a recent publication in BMC Gastroenterology, researchers evaluated the efficacy, safety, and tolerability of high-dose bowel preparations in subjects who previously had an inadequate colonoscopy preparation.
The authors wrote, “Inadequate bowel preparation for colonoscopy remains an issue resulting in lower adenoma detection rates and increased cost.”
The primary objectives of this study were to investigate the efficacy and safety of high-dose polyethylene glycol 3350 (PEG) and Gatorade preparations for a morning colonoscopy. The secondary objectives of this study were to explore the tolerability and patient acceptance of high-dose bowel preparations.
This study was a multistep prospective and nonblind trial of high-dose bowel preparations with subjects allocated to the dose higher than their previous inadequate preparation.
The authors wrote, “Our prospective, non-blinded study of high doses of PEG (459 g to 612 g) and Gatorade given as part of a multi-step escalating extended cleansing protocol is the first to report the efficacy, tolerance, and safety of any high-dose preparation for subjects whose colons were inadequately cleansed for a previous colonoscopy.”
For this study, Step 1 was 1.5 times the standard dose of PEG (459 g) and Gatorade; and Step 2 was 2.0 times the standard dose of PEG (612 g) and Gatorade. Both steps were administered as extended split-dose preparations. A total of 69 outpatients consumed their preparation before a morning colonoscopy.
Using the Chicago bowel preparation scale (BPS), the primary endpoint—which was colon cleanliness—was evaluated. The safety of the preparations was evaluated by comparing a baseline basic metabolic panel (BMP) to a postcleansing BMP.
Patients with no history of inadequate colon cleansing who consumed standard doses of PEG (306 g to 357 g) and Gatorade were employed as a comparison group, and the tolerability of the bowel preparation was measured using a subject questionnaire.
The results revealed that when compared with control subjects consuming standard-dose bowel preparations, subjects consuming high-dose preparations had no statistically significant variance in colon cleanliness as measured by the modified or total Chicago BPS scores or differences in tolerability. The authors also noted that baseline and postcleansing BMPs were not drastically different, other than the blood urea nitrogen falling (P <.0001) after the preparation.
Based on their findings, the authors indicated that the multistep, high-dose, bowel-cleansing protocol provides clinical evidence that it is extremely efficacious, safe, and well tolerated in subjects who formerly had an inadequate colonoscopy preparation.
The authors concluded, “With this study, we continue to show how the flexible dosing of PEG and Gatorade allows the needs of a diverse patient population to be met. Patients willing to consume a split-dose preparation do well with 306 g of PEG, patients who want a day-prior preparation require 357 g of PEG, and we have observed patients with a history of a borderline inadequate preparation doing well with 374 g of PEG given as a spit-dose.”
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