Año 2024 / Volumen 116 / Número 11
Original
Effectiveness and safety of a 1-L polyethylene glycol and ascorbic acid preparation for colonoscopy in routine clinical practice in Spain

599-605

DOI: 10.17235/reed.2024.10426/2024

Vicente Lorenzo-Zúñiga García, Fernando Sábado Martí, Miguel Ángel Pantaleón Sánchez, Salvador Machlab Mashlab, David Carral Martínez, Blas José Gómez Rodríguez, Antonio López Cano, Sarbelio Rodríguez Muñoz, Elena Pérez Arellano, Carmen Turbi Disla, José Miguel Esteban López-Jamar,

Resumen
Background and aims: large clinical trials and small real-world studies show that a 1-L polyethylene glycol and ascorbic acid solution (1-L PEG-ASC) is an effective and safe bowel preparation for colonoscopy. Here, the effectiveness and safety of 1-L PEG-ASC was evaluated in a large cohort of patients in routine clinical practice in Spain. Methods: a sub-analysis was performed in an observational, multicenter, retrospective study assessing the effectiveness and safety of 1-L PEG-ASC in adult patients undergoing a colonoscopy at ten centers in Spain. Cleansing quality was assessed with the Boston Bowel Preparation Scale, scores ≥ 6 with all segmental scores ≥ 2 were considered as adequate colon cleansing, and high-quality was considered as cleansing ≥ 8 or = 3 in the right colon. Polyp and adenoma detection rates, and adverse events were also assessed. Results: data were collected from 7,160 patients; 48.3 % were males, mean age was 58.0 and 33.6 % were ≥ 65 years old. Adequate overall bowel cleansing was achieved in 95.6 % of patients (95 % CI: 95.1-96.0 %), high quality cleansing in 74.4 % (95 % CI: 73.4-75.4 %) and high-quality right colon cleansing in 66.0 % (95 % CI: 64.9-67.1). The adequate overall cleansing rate was 97.0 % with a split-dose and 94.0 % with same-day regimen (p < 0.0001), and high-quality right colon cleansing was 69.0 % and 62.5 % (p < 0.0001), respectively. Colonoscopy was completed in 97.2 % of cases. A multivariate regression analysis revealed that an overnight split-dose regimen and age < 65 years were independent predictors of adequate bowel cleansing of the overall colon, age < 65 years and female gender were independent predictors of high quality (HQ) cleansing of the overall colon, and the three covariates were independent predictors of HQ cleansing of the right colon. At least one adverse event was experienced by 3.3 % of participants, with nausea (1.5 %) and vomiting (1.2 %) being the most frequent. Conclusion: this sub-analysis confirmed 1-L PEG-ASC to be an effective and safe bowel cleansing preparation in a real world setting in Spain.
Resumen coloquial
It is well known that the quality of a colonoscopy is dependent on adequate bowel cleansing, which can affect both diagnostic accuracy and the rate of adenoma detection, with an excellent degree of cleansing believed to result in a higher detection rate. Here, a sub-analysis was performed of an observational, multicentre, retrospective study that assessed the effectiveness and safety of a 1L solution of polyethylene glycol and ascorbic acid as a preparative regimen for colonoscopy in routine clinical practice, based on the data from 10 centres in Spain. Adequate and high-quality cleansing of the overall colon, as well as specifically of the right colon, was achieved with this preparation, exceeding the minimum European Society of Gastrointestinal Endoscopy standards. The afternoon-morning split-dose preparation achieved significantly better adequate and high-quality overall and right colon cleansing. This was also the case for other parameters of colonoscopy effectiveness, such as the rate of adenoma and polyp detection, the cecal intubation rate and withdrawal time. The split-dose preparation, age <65 years and female gender were factors related to high-quality right colon cleansing. Moreover, colonoscopy was not completed due to poor preparation in only 0.3 % of patients. Very few adverse events were associated with the use of this solution, only reported by 3.3% of patients, all of which were mild and mainly involved nausea or vomiting. In summary, the study shows the effectiveness and safety of using this ultra-low-volume bowel cleansing preparation in adults prior to colonoscopy in routine clinical practice in Spain.
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Bibliografía
1. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008;58:130–160.
2. Froehlich F, Wietlisbach V, Gonvers J-J, et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc 2005;61:378–384.
3. Rex DK, Imperiale TF, Latinovich DR, et al. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol 2002;97:1696–1700.
4. Wexner SD, Beck DE, Baron TH, et al. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Gastrointest Endosc 2006;63:894–909.
5. Hillyer GC, Basch CH, Lebwohl B, et al. Shortened surveillance intervals following suboptimal bowel preparation for colonoscopy: results of a national survey. Int J Colorectal Dis 2013;28:73–81.
6. Yadlapati R, Johnston ER, Gregory DL, et al. Predictors of Inadequate Inpatient Colonoscopy Preparation and Its Association with Hospital Length of Stay and Costs. Dig Dis Sci 2015;60:3482–3490.
7. Kaminski M, Thomas-Gibson S, Bugajski M, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017;49:378–397.
8. Sulz MC, Kröger A, Prakash M, et al. Meta-Analysis of the Effect of Bowel Preparation on Adenoma Detection: Early Adenomas Affected Stronger than Advanced Adenomas. PLoS One 2016;11:e0154149.
9. Harewood GC, Sharma VK, Garmo P de. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc 2003;58:76–79.
10. Hassan C, Manning J, Álvarez González MA, et al. Improved detection of colorectal adenomas by high-quality colon cleansing. Endosc Int Open 2020;8:E928–E937.
11. Clark BT, Rustagi T, Laine L. What level of bowel prep quality requires early repeat colonoscopy: systematic review and meta-analysis of the impact of preparation quality on adenoma detection rate. Am J Gastroenterol 2014;109:1714–1723; quiz 1724.
12. Bisschops R, Manning J, Clayton LB, et al. Colon cleansing efficacy and safety with 1 L NER1006 versus 2 L polyethylene glycol + ascorbate: a randomized phase 3 trial. Endoscopy 2019;51:60–72.
13. DeMicco MP, Clayton LB, Pilot J, et al. Novel 1 L polyethylene glycol-based bowel preparation NER1006 for overall and right-sided colon cleansing: a randomized controlled phase 3 trial versus trisulfate. Gastrointest Endosc 2018;87:677-687.e3.
14. Schreiber S, Baumgart DC, Drenth JPH, et al. Colon cleansing efficacy and safety with 1 L NER1006 versus sodium picosulfate with magnesium citrate: a randomized phase 3 trial. Endoscopy 2019;51:73–84.
15. Maida M, Sinagra E, Morreale GC, et al. Effectiveness of very low-volume preparation for colonoscopy: A prospective, multicenter observational study. World J Gastroenterol 2020;26:1950–1961.
16. Bednarska O, Nyhlin N, Schmidt PT, et al. The Effectiveness and Tolerability of a Very Low-Volume Bowel Preparation for Colonoscopy Compared to Low and High-Volume Polyethylene Glycol-Solutions in the Real-Life Setting. Diagnostics (Basel) 2022;12:1155.
17. López-Jamar JME, Gorjão R, Cotter J, et al. Bowel cleansing effectiveness and safety of 1L PEG + Asc in the real-world setting: Observational, retrospective, multicenter study of over 13000 patients. Endosc Int Open 2023;11:E785–E793.
18. Kaminski MF, Thomas-Gibson S, Bugajski M, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United European Gastroenterol J 2017;5:309–334.
19. Clark BT, Laine L. High-quality Bowel Preparation Is Required for Detection of Sessile Serrated Polyps. Clin Gastroenterol Hepatol 2016;14:1155–1162.
20. Maida M, Ventimiglia M, Facciorusso A, et al. Effectiveness and safety of 1-L PEG-ASC versus other bowel preparations for colonoscopy: A meta-analysis of nine randomized clinical trials. Dig Liver Dis 2023;55:1010–1018.
21. Michalopoulos G, Tzathas C. Serrated polyps of right colon: guilty or innocent? Ann Gastroenterol 2013;26:212–219.
22. Eun CS, Han DS, Hyun YS, et al. The timing of bowel preparation is more important than the timing of colonoscopy in determining the quality of bowel cleansing. Dig Dis Sci 2011;56:539–544.
23. Siddiqui AA, Yang K, Spechler SJ, et al. Duration of the interval between the completion of bowel preparation and the start of colonoscopy predicts bowel-preparation quality. Gastrointest Endosc 2009;69:700–706.
24. Wieszczy P, Bugajski M, Januszewicz W, et al. Comparison of Quality Measures for Detection of Neoplasia at Screening Colonoscopy. Clin Gastroenterol Hepatol 2023;21:200-209.e6.
25. Francis DL, Rodriguez-Correa DT, Buchner A, et al. Application of a conversion factor to estimate the adenoma detection rate from the polyp detection rate. Gastrointest Endosc 2011;73:493–497.
26. Kaminski MF, Wieszczy P, Rupinski M, et al. Increased Rate of Adenoma Detection Associates With Reduced Risk of Colorectal Cancer and Death. Gastroenterology 2017;153:98–105.
27. Gurudu SR, Ramirez FC, Harrison ME, et al. Increased adenoma detection rate with system-wide implementation of a split-dose preparation for colonoscopy. Gastrointest Endosc 2012;76:603-608.e1.
28. Sullivan BA, Noujaim M, Roper J. Cause, Epidemiology, and Histology of Polyps and Pathways to Colorectal Cancer. Gastrointest Endosc Clin N Am 2022;32:177–194.
29. Baxter NN, Sutradhar R, Forbes SS, et al. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology 2011;140:65–72.
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Lorenzo-Zúñiga García V, Sábado Martí F, Pantaleón Sánchez M, Machlab Mashlab S, Carral Martínez D, Gómez Rodríguez B, et all. Effectiveness and safety of a 1-L polyethylene glycol and ascorbic acid preparation for colonoscopy in routine clinical practice in Spain. 10426/2024


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Ficha Técnica

Recibido: 24/03/2024

Aceptado: 18/07/2024

Prepublicado: 01/08/2024

Publicado: 11/11/2024

Tiempo de revisión del artículo: 106 días

Tiempo de prepublicación: 130 días

Tiempo de edición del artículo: 232 días


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