Year 2024 / Volume 116 / Number 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,

Abstract
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.
Lay Summary
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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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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Publication history

Received: 24/03/2024

Accepted: 18/07/2024

Online First: 01/08/2024

Published: 11/11/2024

Article revision time: 106 days

Article Online First time: 130 days

Article editing time: 232 days


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