利那洛肽联合复方聚乙二醇在结肠镜肠道准备中应用的初步研究

目的　初步探索利那洛肽联合复方聚乙二醇（polyethylene glycol，PEG）在结肠镜肠道准备中的作用。方法　本试验是一项多中心随机对照研究。连续纳入2021年11月—2022年3月在上海长海医院、山西省人民医院和联勤保障部队第九〇〇医院3家消化内镜中心接受结肠镜检查的受试者，采用完全随机法分成3组，A组肠道准备方案为3 d利那洛肽+3 L PEG，B组为仅3 L PEG，C组为3 d利那洛肽+2 L PEG。主要观察指标为肠道准备合格率，次要观察指标包括肠道准备优秀率、肠道准备完成率以及肠道准备愿意重复率。结果　共入组130例受试者，其中A组46例，B组43例，C组41例，3组受试者肠道准备合格率［95.7%（44/46）、93.0%（40/43）和95.1%（39/41），χ2=0.465，P=0.893］，肠道准备优秀率［43.5%（20/46）、25.6%（11/43）和34.1%（14/41），χ2=3.151，P=0.207］及肠道准备完成率［95.7%（44/46）、95.3%（41/43）和100.0%（41/41），χ2=1.909，P=0.544］差异均无统计学意义。3组受试者愿意再次行相应肠道准备方案的愿意重复率差异有统计学意义［89.1%（41/46）、74.4%（32/43）和100.0%（41/41），χ2=12.862，P=0.002］。C组受试者肠道准备完成率和愿意重复率均为100.0%，较A、B两组有升高趋势。结论　利那洛肽有提高肠道准备质量的趋势，可以减少PEG用量。     

新型口服硫酸盐溶液用于结肠镜肠道准备的Ⅲ期随机对照研究

目的　探讨口服硫酸盐溶液（oral sulfate solution,OSS）与聚乙二醇（polyethylene glycol,PEG）电解质散用于结肠镜检查前肠道准备的疗效。方法　全国9家中心纳入283例受试者随机应用OSS（143例）和PEG（140例）2 d分次方案进行肠道准备,进行了结肠镜检查并接受评估。主要研究终点为肠道准备成功率［独立评审中心评估波士顿肠道准备评分量表（Boston bowel preparation scale,BBPS）评分≥6分］,次要研究终点包括BBPS总分和分肠段评分、研究者对肠道准备的满意度（5分制Likert量表评估）,以及通过调查问卷评估患者满意度,采用Sharma量表评估患者耐受性并比较两组的依从性和安全性。结果　OSS组和PEG组肠道准备成功率分别为100.0%和99.3%［校正后差异0.7%（95%CI：-5.3%~6.7%）,非劣效检验,P<0.001］。OSS组BBPS评分总分显著高于PEG组（8.1分比7.7分,P<0.001）,所有分肠段BBPS也高于PEG组（右半结肠：2.4分比2.3分,P=0.002;横结肠：2.8分比2.7分,P=0.018;左半结肠：2.8分比2.7分,P=0.007）。OSS组研究者Likert评分明显高于PEG组（2.6分比2.3分,P<0.001）。OSS组总体依从性和PEG相当,但第2次给药依从性显著高于PEG（90.9%比82.6%,P=0.039）。两组患者满意度、Sharma量表评分以及出现耐受性相关症状受试者比例未见明显差异。两组安全性相当,不良事件均为轻中度。结论　OSS用于肠道准备效果和PEG相当,其具有较高的全肠段BBPS评分和研究者满意度,分次给药时患者依从性较PEG更好,耐受性和安全性与PEG相当。     

硫酸镁钠钾口服液用于成人结肠镜检查前肠道准备有效性和安全性的Ⅲ期临床多中心随机对照研究

目的　评价硫酸镁钠钾口服液（oral sulfate solution,OSS）用于成人结肠镜检查前肠道准备的有效性和安全性。方法　采用多中心、随机、研究者单盲、阳性对照、非劣效性临床研究。受试者随机接受结肠镜检查前分次服用共2瓶OSS（177 mL/瓶）或4 L复方聚乙二醇电解质散（Ⅲ）（polyethylene glycol,PEG）的肠道准备方案。主要疗效指标为肠道准备的有效性。波士顿评分量表（Boston bowel preparation scale,BBPS）各节段（右侧结肠、中段结肠和左侧结肠）评分均≥2分定义为有效。次要疗效指标包括受试者的依从性和结肠镜下肠腔气泡评估,同时包括服药后排便间隔时间、服药后大便呈Ⅶ型（Bristol大便分类法）间隔时间、排便次数、结肠镜检查阳性率（息肉、非息肉性隆起、溃疡等检出率）,以及通过不良事件和严重不良事件的发生情况来评估安全性。结果　共4家医院的240名受试者参加研究,其中试验组（OSS组）120例,对照组（PEG组）120例。全分析集（full analysis set,FAS）分析显示OSS组与PEG组的肠道准备成功率分别为92.44%（110/119）和91.60%（109/119）（χ2=0.058,P=0.809）。除FAS分析左侧结肠BBPS评分差异无统计学意义外,FAS和符合方案集（per protocol set,PPS）分析均显示OSS组BBPS总分及各肠段评分均优于PEG组。OSS组的气泡评估满意率高于PEG组（95.80%比89.08%,P=0.025）,两组的依从性、结肠镜检查阳性率和安全性相似。结论　OSS方案的肠道准备质量不低于4 L PEG方案,消泡效果好,安全性相当。     

钛夹联合尼龙绳牵引辅助技术在内镜黏膜下剥离术治疗早期胃角癌中的临床研究

目的 评估钛夹联合尼龙绳牵引辅助下内镜黏膜下剥离术（ESD）治疗早期胃角癌及癌前病变的应用价值及安全性。方法 以2018年1—12月在杭州市第一人民医院行ESD治疗的59例早期胃角癌及癌前病变患者为研究对象,采用随机数字表法随机分入常规ESD组（对照组,n=28）和钛夹联合尼龙绳牵引组（试验组,n=31）。比较两组患者的黏膜下补充注射次数、ESD手术时间、病灶面积、黏膜剥离时间、单位时间切除率、病灶完整切除率以及手术并发症等情况。结果 试验组黏膜下补充注射次数少于对照组[（2.3±1.1）次比（3.7±1.4）次,t=4.557,P＜0.001];试验组的病灶面积和对照组相比差异无统计学意义 [（12.7±2.6）cm2比（11.7±2.7）cm2,t=1.485,P=0.143];试验组ESD手术时间[（72.4±24.7）min比（93.6±28.9）min,t=3.043,P=0.004]和黏膜剥离时间[（67.7±23.3）min比（88.2±28.3）min,t=3.054,P=0.003]短于对照组,单位时间切除率高于对照组[（20.2±3.2）mm2/min比（14.3±3.4）mm2/min,t=6.879,P＜0.001]。两组患者的一次性完整切除率均为100.0%。两组患者均未出现穿孔及术后出血等,试验组术中出血率低于对照组[19.4%（6/31）比35.7%（10/28）, χ2=1.992,P=0.158]。结论 使用钛夹联合尼龙绳牵引辅助技术可降低胃角ESD的技术难度、缩短操作时间、降低术中出血可能,具有较好的应用价值。     

Bristol粪便性状评估表在儿童结肠镜检查前肠道准备中的应用研究

目的 评价Bristol粪便性状评估表（BSFS）用于儿童结肠镜检查前肠道准备的临床价值,并探讨其影响因素。 方法 采用方便抽样方法,以2016年5月至2016年12月收治于复旦大学附属儿科医院消化科拟行结肠镜检查的患儿为研究对象,经排除标准排除后共202例患儿纳入研究,统一使用聚乙二醇-4000分剂量服用联合饮食限制行肠道准备的方案。术前使用BSFS评估每次解便的性状,检查当日6∶00查看最近1次解便的性状,BSFS≤5分者加服聚乙二醇-4000（20 mL／kg）,11∶00查看末次解便的性状,BSFS≤5分者取消当日结肠镜检查并延长肠道准备时间,BSFS 6分者予温生理盐水灌肠（灌肠组）,BSFS 7分者不予温生理盐水灌肠（不灌肠组）。13∶00行结肠镜检查,术中使用Boston肠道准备评分表（BBPS）记录镜下视野清晰度,分为优、良、一般、差,其中优、良定义为肠道准备合格。灌肠组和不灌肠组肠道准备合格率比较使用卡方检验。按肠道准备是否合格分成2组（合格组和不合格组）,根据数据类型,使用t（或t′）检验或卡方检验分析肠道准备质量的影响因素,单因素分析筛选出的因素再纳入多因素logistic回归分析,以寻求影响肠道准备质量的独立危险因素。检验水准为α=0.05。 结果 202例患儿在肠道准备期间平均排便次数为（14.4±6.8）次,不灌肠组165例（81.7％）,灌肠组37例（18.3％）,肠道准备合格患儿154例（76.2％）,其中不灌肠组肠道准备合格率为75.2％（124／165）,灌肠组肠道准备合格率为81.1％（30／37）,2组肠道准备合格率比较差异无统计学意义（χ2=0.587,P=0.526）。单因素分析发现,合格组与不合格组在便秘史（χ2=32.588,P=0.000）、解便总次数（t=3.432,P=0.001）、BSFS 7分的次数（t′=2.877,P=0.005）方面差异有统计学意义。进一步多因素logistic回归分析显示,便秘史是肠道准备不合格的独立危险因素（P=0.000,OR=12.620,95％CI：4.850～32.800）。 结论 对于儿童结肠镜检查前的肠道准备,术前肉眼观察粪便性状并采用BSFS进行把控具有较好的临床应用价值,肠道准备合格率较高。但对于有便秘史的患儿,建议适当延长肠道准备时间以确保镜下视野清晰度。     

单倍剂量磷酸钠联合莫沙比利在结肠镜检患者肠道准备中的应用

目的 观察单倍剂量（45 ml）磷酸钠口服溶液联合莫沙比利用于肠道准备的效果及耐受性.方法 将同期拟行结肠镜检查的117例患者随机分为A组63例和B组54例,A组检查见1 d口服莫沙比利、检查日口服磷酸钠口服溶液45 ml, B组按常规方法服用双倍剂量磷酸钠盐口服液.记录肠道清洁效果及患者对肠道准备方法耐受程度.结果 A、B组肠道清洁效果满意率分别为93.7%（59/63）、94.4%（51/54）,患者对肠道准备方法耐受满意率分别为100.0%（63/63）、94.4%（51/54）,P均〉0.05.结论 单倍剂量磷酸钠盐口服液联合莫沙比利用于肠道准备清肠效果满意、患者耐受性好.     

潜水胶囊内镜的临床初步应用

目的 比较传统胶囊内镜与潜水胶囊内镜的肠道准备质量及病变检出情况。方法 回顾性分析2016年3月至2017年3月在我院接受胶囊内镜检查的连续60例患者胶囊内镜检查资料，前30例患者采用常规方法进行肠道准备（传统胶囊内镜组），后30例患者采用潜水法进行肠道准备（潜水胶囊内镜组），比较肠道准备评分、胶囊内镜平均胃通过时间（GTT）、小肠通过时间（SBTT）、胶囊内镜检查完成率以及阳性病变检出率等。结果 传统胶囊内镜组患者肠道准备评分平均为2.56±0.71分，显著低于潜水胶囊内镜组3.24±0.71分（t=3.768，p<0.001）。传统胶囊内镜组平均GTT 40.86±35.91min、SBTT 314.20±151.30min、结肠到达率100%；潜水胶囊内镜组患者平均GTT 52.82±38.96min、SBTT 282.44±123.23min、结肠到达率90%，组间差异无统计学意义（p=0.233、0.392、0.237）。传统胶囊内镜组患者中阳性病变检出率为73.3% (22/30)，潜水胶囊内镜组阳性病变检出率为80% (24/30)，两组数据无显著差异（χ２=0.373，p=0.542）。结论 潜水胶囊内镜较传统胶囊内镜肠道准备质量显著提高，且有提高病变阳性检出率的趋势。     

利那洛肽联合复方聚乙二醇电解质散用于结肠镜肠道准备的临床研究

目的探讨利那洛肽联合复方聚乙二醇电解质散(polyethylene glycol electrolytes powder, PEG)作为结肠镜肠道准备方案的价值。方法采用随机、单盲的前瞻性临床研究, 纳入2021年6—8月于南方医科大学深圳医院消化内科门诊行结肠镜检查的患者。将行结肠镜肠道准备的患者分成2组, 试验组152例患者采用580 μg利那洛肽+2 L PEG方案, 对照组152例患者采用3 L PEG方案。比较两组患者肠道准备效果(波士顿肠道准备量表评分、气泡评分和病变检出率)及安全性(不良事件)。结果试验组与对照组相比, 波士顿肠道准备量表评分[总评分9(8, 9)分比9(9, 9)分, Z=0.141, P=0.888], 气泡评分[1(1, 2)分比1(1, 1)分, Z=1.788, P=0.074]及总体病变检出率[37.50%(57/152)比33.55%(51/152), χ2=0.517, P=0.472]差异均无统计学意义。在安全性方面, 试验组与对照组相比, 恶心[7.24%(11/152)比13.16%(20/152), χ2=2.910, P=0.08...     

链霉蛋白酶与二甲硅油对胃镜检查微小病变检出率影响的比较

探讨链霉蛋白酶与二甲硅油对胃镜检查微小病变检出率影响，统计353例接受无痛胃镜检查的患者，分为试验组（予链霉蛋白酶联合碳酸氢钠）176例和对照组（予二甲硅油联合碳酸氢钠）177例。记录两组胃镜检查时视野清晰度、检查时长、冲洗次数、微小病灶检出率、早期癌检出率及不良反应发生率等临床指标。试验组和对照组比较视野清晰度［（1.84±0.51）分比（2.15±0.48）分，t=-5.900］、胃底黏液性状［（1.04±0.43）分比（1.46±0.76）分，t=-6.347］和冲洗次数［（0.76±0.66）次比（1.18±0.72）次，t=-5.628］等方面，差异有统计学意义（P<0.001）。试验组检查时长略高于对照组［（10.01±4.40）min比（8.98±4.22）min，t=2.239，P=0.026］。试验组微小病变检出率显著高于对照组］［97.73%（172/176）比91.53%（162/177），χ2=6.665，P=0.010］。在炎性增生、息肉、癌前病变和癌的检出率方面，试验组与对照组差异均无统计学意义（P>0.05）。两组患者均无术前喝药不适，试验组和对照组各有4例发生术中呛咳，术中呛咳发生率差异无统计学意义（P>0.999），术后均无不良反应。术前服用链霉蛋白酶可显著提高胃镜下视野清晰度并提高微小病变检出率，有助于发现胃内早期病变。     

短视频教育对结肠镜检查肠道准备质量的影响

[目的]探讨短视频教育对结肠镜受检者肠道准备质量的影响。[方法]将182例结肠镜受检者分为对照组(90例)和观察组(92例)。对照组按传统方法进行肠道准备指导,观察组在此基础上给予短视频教育;比较2组患者的肠道准备质量。[结果]观察组Boston肠道准备量表评分[(7.24±1.46)分]及肠道准备合格率(85.9%)均高于对照组[(6.17±2.33)分、68.9%],P0.01;插镜时间较对照组显著缩短[(7.0±3.4)min∶(8.9±4.2)min],P0.05。观察组对肠道准备要求的依从性评分[(5.78±0.18)分]、检查前1d饮食依从性(92.4%)、服药总量(95.7%)和服药速度的依从性(95.7%)均明显高于对照组[(5.19±0.70)分、65.6%、86.7%、84.4%],分别为P0.05、P0.01、P0.05、P0.05。[结论]短视频教育有助于改善结肠镜受检者的肠道准备质量、插镜时间和肠道准备方案依从性。     

Electrolyte changes after bowel preparation for colonoscopy:A randomized controlled multicenter trial

AIM:To investigate the electrolyte changes between 2-L polyethylene glycol with ascorbic acid 20 g(PEGAsc) and 4-L PEG solutions.METHODS:From August 2012 to February 2013,a total of 226 patients were enrolled at four tertiary hospitals.All patients were randomly allocated to a PEG-Asc group or a 4-L PEG.Before colonoscopy,patients completed a questionnaire to assess bowel preparation-related symptoms,satisfaction,and willingness.Endoscopists assessed the bowel preparation using the Boston Bowel Preparation Scale(BBPS).In addition,blood tests,including serum electrolytes,serum osmolarity,and urine osmolarity were evaluated both before and after the procedure.RESULTS:A total of 226 patients were analyzed.BBPS scores were similar and the adequate bowel preparation rate(BBPS≥6)was not different between the two groups(PEG-Asc vs 4-L PEG,73.2%vs 76.3%,P=0.760).Bowel preparation-related symptoms also were not different between the two groups.The taste of PEG-Asc was better(41.1%vs 16.7%,P0.001),and the willingness to undergo repeated bowel preparation was higher in the PEG-Asc group(73.2%vs 59.3%,P=0.027)than in 4-L PEG.There were no significant changes in serum electrolytes in either group.CONCLUSION:In this multicenter trial,bowel preparation with PEG-Asc was better than 4-L PEG in terms of patient satisfaction,with similar degrees of bowel preparation and electrolyte changes.     

Comparison of the efficacy and safety between oral sulfate tablet and polyethylene glycol for bowel preparation before colonoscopy according to age

Background:Recently, a novel oral sulfate tablet (OST) has been introduced for bowel preparation before colonoscopy. However, whether elderly patients can take OST is not yet clear, as OST consists of 28 tablets. We aimed to compare the efficacy and safety of OST and polyethylene glycol (PEG) for bowel preparation for colonoscopy according to age.Methods:We randomly divided subjects into an OST group and a PEG group and compared Boston Bowel Preparation Score (BBPS), bubble score, patient compliance and satisfaction, and safety between the 2 groups according to age (under 65 years of age vs 65 years of age and older).Results:Among the 179 participants, 61 were 65 years of age and older. The BBPS and bubble score of the OST group were better than that of the PEG group, regardless of age. The satisfaction of the OST group was better than that of the PEG group, regardless of age. The compliance was not different between the 2 groups; however, the OST group under 65 years of age had a higher rate of completing the dose within 2 hours compared with the PEG group under 65 years of age. Adverse events including abdominal distension, abdominal pain, nausea, or vomiting were not different between the 2 groups.Conclusion:The use of OST for bowel preparation before colonoscopy is as effective and safe as PEG, and these results were consistent in elderly people 65 years of age and older.     

Importance of reporting segmental bowel preparation scores during colonoscopy in clinical practice

AIM: To evaluate the impact of reporting bowel preparation using Boston Bowel Preparation Scale(BBPS) in clinical practice.METHODS: The study was a prospective observational cohort study which enrolled subjects reporting for screening colonoscopy. All subjects received a gallon of polyethylene glycol as bowel preparation regimen. After colonoscopy the endoscopists determined quality of bowel preparation using BBPS. Segmental scores were combined to calculate composite BBPS. Site and size of the polyps detected was recorded. Pathology reports were reviewed to determine advanced adenoma detection rates(AADR). Segmental AADR's were calculated and categorized based on the segmental BBPS to determine the differential impact of bowel prep on AADR. RESULTS: Three hundred and sixty subjects were enrolled in the study with a mean age of 59.2 years, 36.3% males and 63.8% females. Four subjects with incomplete colonoscopy due BBPS of 0 in any segment were excluded. Based on composite BBPS subjects were divided into 3 groups; Group-0(poor bowel prep, BBPS 0-3) n = 26(7.3%), Group-1(Suboptimal bowel prep, BBPS 4-6) n = 121(34%) and Group-2(Adequate bowel prep, BBPS 7-9) n = 209(58.7%). AADR showed a linear trend through Group-1 to 3; with an AADR of 3.8%, 14.8% and 16.7% respectively. Also seen was a linear increasing trend in segmental AADR with improvement in segmental BBPS. There was statistical significant difference between AADR among Group 0 and 2(3.8% vs 16.7%, P 0.05), Group 1 and 2(14.8% vs 16.7%, P 0.05) and Group 0 and 1(3.8% vs 14.8%, P 0.05). χ2 method was used to compute P value for determining statistical significance.CONCLUSION: Segmental AADRs correlate with segmental BBPS. It is thus valuable to report segmental BBPS in colonoscopy reports in clinical practice.     

Sodium Picosulfate with Magnesium Citrate (SPMC) Plus Laxative Is a Good Alternative to Conventional Large Volume Polyethylene Glycol in Bowel Preparation: A Multicenter Randomized Single-Blinded Trial

Background/Aims

We investigated whether sodium picosulfate with magnesium citrate (SPMC) plus bisacodyl compares favorably with conventional polyethylene glycol (PEG) with respect to bowel cleansing adequacy, compliance, and safety.

Methods

We performed a multicenter, prospective, single-blinded study in outpatients undergoing daytime colonoscopies. Patients were randomized into a split preparation SPMC/bisacodyl group and a conventional split PEG group. We compared preparation adequacy using the Boston bowel preparation scale (BBPS), ease of use using a modified Likert scale (LS), compliance/satisfaction level using a visual analogue scale (VAS), and safety by monitoring adverse events during the colonoscopy between the two groups.

Results

A total of 365 patients were evaluated by intention to treat (ITT) analysis, and 319 were evaluated by per protocol (PP) population analysis (153 for SPMC/bisacodyl, 166 for PEG). The mean total BBPS score was not different between the two groups in both the ITT and PP analyses (p>0.05). The mean VAS score for satisfaction and LS score for the ease of use were higher in the SPMC/bisacodyl group (p<0.001). The adverse event rate was lower in the SPMC/bisacodyl group than in the PEG group (p<0.05).

Conclusions

The SPMC/bisacodyl treatment was comparable to conventional PEG with respect to bowel preparation adequacy and superior with respect to compliance, satisfaction, and safety.     

A Korean experience of the use of Boston Bowel Preparation Scale: A Valid and Reliable Instrument for Colonoscopy-Oriented Research

Background/Aims:

Few bowel preparation scales have been validated. The Boston Bowel Preparation Scale (BBPS) is a novel bowel preparation scale in western countries. We validated the BBPS in Korean patients and assessed the relationship between the colon polyp detection rate and BBPS score.

Patients and Methods:

This study was a prospective, single-center trial. The BBPS is a 10-point scale that assesses bowel preparation after the completion of all cleansing maneuvers. We assessed three segment scores (the right side, transverse section, and left side) and total BBPS scores during screening colonoscopy. In addition, we compared the BBPS scores with clinically meaningful outcomes such as the polyp detection rate and colonoscope withdrawal times.

Results:

We enrolled 482 screening colonoscopies between January 2011 and January 2012. The mean (± standard deviation [SD]) BBPS score was 8.1 ± 1.1. Higher BBPS scores (≥8 vs <8) were associated with a higher polyp detection rate (44.9% vs. 33.0%, P = 0.042). The BBPS scores were inversely correlated with colonoscope withdrawal times (r = −0.167, P < 0.001).

Conclusions:

The BBPS is a valid and reliable measure for assessing bowel preparation during colonoscopy in Korean patients. The polyp detection rate is higher in patients with higher BBPS scores than in those with lower BBPS scores during a colonoscopic procedure.     

Is a split-dose regimen of 2 L polyethylene glycol plus ascorbic acid tolerable for colonoscopy in an early morning visit to a comprehensive medical check-up?

AIM To evaluate the effectiveness and tolerability of a split-dose 2L polyethylene glycol (PEG)/ascorbic acid(AA) regimen for healthy examinees who visited for comprehensive medical check-up in the early morning.METHODS From February 2015 to March 2015, examinees of average risk who were scheduled for a colonoscopy in the morning were retrospectively enrolled.RESULTS The 189 examinees were divided into split-dose and non-split-dose groups. The adequacy of bowel preparation for the split-dose group vs the non-splitdose group was 96.8% vs 85.2%, respectively, P0.001, and the compliance of the last meal restrictionwas 74.6% vs 58.2%, respectively, P 0.001. The sleep disturbance (P0.001) was more prevalent in the split-dose group, however the willingness to repeat the same preparation method (P=0.243) was not different in both groups. The split-dose regimen was the most important factor influencing adequate bowel preparation in multivariate analysis(HR=10.89, 95%CI: 6.53-18.17, P0.001).CONCLUSION A split-dose regimen of 2L PEG/AA for an early morning colonoscopy was more effective and showed better compliance for diet restriction without any difference in satisfaction and discomfort. Introducing a split-dose regimen of 2L PEG/AA to morning colonoscopy examinees is effective and tolerable in a comprehensive medical check-up setting.     

Efficacy and tolerability of high and low-volume bowel preparation compared: A real-life single-blinded large-population study

BACKGROUNDLow-volume preparations for colonoscopy have shown similar efficacy compared to high-volume ones in randomized controlled trials (RCT). However, most RCTs do not provide data about clinical outcomes including lesions detection rate. Moreover, real-life comparisons are lacking. AIMTo compare efficacy (both in terms of adequate bowel preparation and detection of colorectal lesions) and tolerability of a high-volume (HV: 4 L polyethylene glycol, PEG) and a low-volume (LV: 2 L PEG plus bisacodyl) bowel preparation in a real-life setting.METHODSConsecutive outpatients referred for colonoscopy were prospectively enrolled between 1 December 2014 and 31 December 2016. Patients could choose either LV or HV preparation, with a day-before schedule for morning colonoscopies and a split-dose for afternoon procedures. Adequate bowel preparation according to Boston Bowel Preparation Scale (BBPS), clinical outcomes including polyp detection rate (PDR), adenoma detection rate (ADR), advanced adenoma detection rate (AADR), sessile/serrated lesion detection rate (SDR) and cancer detection rate and self-reported tolerability of HV and LV were blindly assessed.RESULTSTotal 2040 patients were enrolled and 1815 (mean age 60.6 years, 50.2% men) finally included. LV was chosen by 52% of patients (50.8% of men, 54.9% of women). Split-dose schedule was more common with HV (44.7% vs 38.2%, P = 0.005). High-definition scopes were used in 33.4% of patients, without difference in the two groups (P = 0.605). HV and LV preparations showed similar adequate bowel preparation rates (89.2% vs 86.6%, P = 0.098), also considering the two different schedules (HV split-dose 93.8% vs LV split-dose 93.6%, P = 1; HV day-before 85.5% vs LV day-before 82.3%, P = 0.182). Mean global BBPS score was higher for HV preparations (7.1 ± 1.7 vs 6.8 ± 1.6, P < 0.001). After adjustment for sex, age and indications for colonoscopy, HV preparation resulted higher in PDR [Odds ratio (OR) 1.32, 95%CI: 1.07-1.63, P = 0.011] and ADR (OR 1.29, 95%CI 1.02–1.63, P = 0.038) and comparable to LV in AADR (OR 1.51, 95%CI 0.97-2.35, P = 0.069), SDR and cancer detection rate. The use of standard-definition colonoscopes was associated to lower PDR (adjusted OR 1.59, 95%CI: 1.22-2.08, P < 0.001), ADR (adjusted OR 1.71, 95%CI: 1.26–2.30, P < 0.001) and AADR (adjusted OR 1.97, 95%CI: 1.09-3.56, P = 0.025) in patients receiving LV preparation. Mean Visual Analogue Scale tolerability scored equally (7, P = 0.627) but a ≥ 75% dose intake was more frequent with LV (94.6% vs 92.1%, P = 0.003). CONCLUSIONIn a real-life setting, PEG-based low-volume preparation with bisacodyl showed similar efficacy and tolerability compared to standard HV preparation. However, with higher PDR and ADR, HV should still be considered as the reference standard for clinical trials and the preferred option in screening colonoscopy, especially when colonoscopy is performed with standard resolution imaging.     

莫沙必利联合二甲硅油散在慢性便秘患者结肠镜检查肠道准备中的应用

目的观察胃肠动力药莫沙必利联合二甲硅油散在慢性便秘患者行电子结肠镜检查前肠道准备过程中的应用效果。 方法选取徐州医科大学附属淮安医院拟行电子纤维结肠镜检查的慢性便秘患者300例,采用随机数字表法分为A组(复方聚乙二醇电解质散联合二甲硅油散)150例、B组(在A组的基础上联合莫沙必利口服)150例。采用Boston肠道量表进行肠道准备质量的评分、肠道气泡量表用于评估肠道内气泡的数量,并记录患者肠道准备时间,进镜时间及退镜时间、不良反应发生情况以及肠道疾病检出情况。 结果AB组2组实际完成肠镜检查过程分别为143例和146例,B组BBPS大于6分的比例明显高于A组(χ²＝5.141,P<0.05);B组肠道泡沫量评中I、Ⅱ级所占比例明显高于A组(χ²＝5.851,P<0.05)。且肠道准备所用时间、不良反应发生率及肠道病变检出率,B组也明显优于A组,差异有统计学意义(P<0.05)。 结论莫沙必利联合二甲硅油散作为肠道准备用药可以明显提高慢性便秘患者肠道清洁质量的同时显著减少肠腔内气泡的产生,也能减少肠道准备所用时间、降低不良反应发生率、提高肠道病变的检出率。     

Split-dose vs same-day reduced-volume polyethylene glycol electrolyte lavage solution for morning colonoscopy

AIM: To compare same-day whole-dose vs split-dose of 2-litre polyethylene glycol electrolyte lavage solution (PEG-ELS) plus bisacodyl for colon cleansing for morning colonoscopy.METHODS: Consecutive adult patients undergoing morning colonoscopy were allocated into two groups i.e., same-day whole-dose or split-dose of 2-litre PEG-ELS. Investigators and endoscopists were blinded to the allocation. All patients completed a questionnaire that was designed by Aronchick and colleagues to assess the tolerability of the bowel preparation regime used. In addition, patients answered an ordinal five-value Likert scale question on comfort level during bowel preparation. Endoscopists graded the quality of bowel preparation using the Boston bowel preparation scale (BBPS). In addition, endoscopists gave an overall grading of the quality of bowel preparation. Cecal intubation time, withdrawal time, total colonoscopy time, adenoma detection rate and number of adenomas detected for each patient were recorded. Sample size was calculated using an online calculator for binary outcome non-inferiority trial. Analyses was based upon intent-to-treat. Significance was assumed at P-value < 0.05.RESULTS: Data for 295 patients were analysed. Mean age was 62.0 ± 14.4 years old and consisted of 50.2 % male. There were 143 and 152 patients in the split-dose and whole-dose group, respectively. Split-dose was as good as whole-dose for quality of bowel preparation. The total BBPS score was as good in the split-dose group compared to the whole-dose group [6 (6-8) vs 6 (6-7), P = 0.038]. There was no difference in cecal intubation rate, cecal intubation time, withdrawal time, total colonoscopy time and adenoma detection rate. Median number of adenoma detected was marginally higher in the split-dose group [2 (1-3) vs 1 (1-2), P = 0.010]. Patients in the whole-dose group had more nausea (37.5% vs 25.2%, P = 0.023) and vomiting (16.4% vs 8.4%, P = 0.037), and were less likely to complete the bowel preparation (94.1% vs 99.3%, P = 0.020). Patients in the split-dose group were less likely to refuse the same bowel preparation regime (6.3% vs 13.8%, P = 0.033) and less likely to want to try another bowel preparation regime (53.8% vs 78.9%, P < 0.001).CONCLUSION: Splitting reduced-volume PEG-ELS for morning colonoscopy is as effective as taking the whole dose on the same morning but is better tolerated and preferred by patients.     

Comparison of split-dosing vs non-split (morning) dosing regimen for assessment of quality of bowel preparation for colonoscopy

AIM: To compare (using the Ottawa Bowel Preparation Scale) the efficacy of split-dose vs morning administration of polyethylene glycol solution for colon cleansing in patients undergoing colonoscopy, and to assess the optimal preparation-to-colonoscopy interval.METHODS: Single-centre, prospective, randomized, investigator-blind stud in an academic tertiary-care centre. Two hundred patients requiring elective colonoscopy were assigned to receive one of the two preparation regimens (split vs morning) prior to colonoscopy. Main outcome measurements were bowel preparation quality and patient tolerability.RESULTS: Split-dose regimen resulted in better bowel preparation compared to morning regimen [Ottawa score mean 5.52 (SD 1.23) vs 6.02 (1.34); P = 0.017]. On subgroup analysis, for afternoon procedures, both the preparations were equally effective (P = 0.756). There was no difference in tolerability and compliance between the two regimens.CONCLUSION: Overall, previous evening - same morning split-dosing regimen results in better bowel cleansing for colonoscopy compared to morning preparation. For afternoon procedures, both schedules are equally effective; morning preparation may be more convenient to the patient.