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Low-volume bowel prep still effective, but better tolerated
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Low-volume, split-dose bowel preparations were just as effective as high-volume preps with the added benefit of being better tolerated by patients, according to the results of a metanalysis.
“Suboptimal patient compliance and acceptability have been attributed to the large volume of bowel preparation to be administered, affecting patient experience and willingness to repeat the procedure,” Marco Spadaccini, MD, of the digestive endoscopy unit at Humanitas Research Hospital in Italy, and colleagues wrote. “When considering patient experience as a relevant outcome of bowel preparation, low-volume [polyethylene glycol (PEG)] and non-PEG split regimens appear to be an attractive alternative, due to a substantial reduction in the volume to be administered.”
Investigators searched the literature for randomized-controlled trials that compared low- and high-volume cleansing regimens administered in a split dose. Rate of adequate bowl cleansing was the primary outcome, while adenoma detection was the secondary efficacy outcome. Researchers also assessed tolerability outcomes, including compliance, tolerability and willingness to repeat.
Seventeen studies comprising 7,528 patients fit the researchers criteria. Overall, they found no difference in adequacy of bowel cleansing between the low- and high-dose regimens (86.1% vs. 87.4%). Additionally, they found no difference in adenoma detection rate (RR = 0.96; 95% CI, 0.87–1.08).
Although the different regimens had similar bowel cleansing ability, patients had a clear preference. Spadaccini and colleagues found that low-volume regimens had higher odds for compliance or completion (RR = 1.06; 95% CI, 1.02–1.1), tolerability (RR = 1.39; 95% CI, 1.12–1.74) and willingness to repeat (RR = 1.41; 95% CI, 1.2–1.66) compared with the high-volume prep.
“When coupling the equivalent efficacy with a better experience, there is compelling evidence to recommend a low-volume split regimen as alternative to the high-volume regimen, unless additional factors, such as cost or patient preferences, supports a different choice,” they wrote. – by Alex Young
Disclosures: Spadaccini reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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