Scand J Gastroenterol. 2023 Jun;58(6):656-663.doi: 10.1080/00365521.2022.2153618. Epub 2022 Dec 15.

Jose Luis Rueda García ^1 2, Cristina Suárez Ferrer ^1 2, Eduardo Martín-Arranz ^1 2, Laura García-Ramírez ^1 2, María Sánchez-Azofra ^1 2, Joaquín Poza Cordón ^1 2, Jesús Noci ^1 2, Tamara Vergés ^1 2, Paula Blanco San Miguel ^1 2, María Dolores Martín-Arranz ^1 2 3; IdiPAZ Study Group for Immune-Mediated Gastrointestinal Diseases

Author information

¹Inflammatory Bowel Disease Unit, Gastroenterology Department, La Paz University Hospital, Madrid, Spain.

²La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.

³School of Medicine, Autonomous University of Madrid, Madrid, Spain.

Abstract

Background: Data regarding bowel preparation in patients with Inflammatory Bowel Disease (IBD) are scarce.

Aim: To compare efficacy, safety, and tolerability of low-volume preparations in patients with IBD.

Methods: Single-center, randomized, prescriber, and colonoscopist-blinded clinical trial. IBD outpatients undergoing colonoscopy were randomized 1:1:1 to receive 1 Liter-polyethylene glycol-ascorbate (1L-PEG), 2 Liters-PEG, or sodium picosulfate (SP). The primary endpoint was percentage of quality cleansing assessed via the Boston Bowel Preparation Scale (BBPS ≥6, segments ≥2). Secondary endpoints were total high quality cleansing (BBPS 8 or 9), high-quality segmental BBPS (≥2), and patients' tolerability, symptoms, and satisfaction, assessed by questionnaires. Safety was monitored by adverse event reporting, laboratory evaluation at colonoscopy, and telephonic follow-up.

Results: Ninety-two patients were included (33 1L-PEG, 28 2L-PEG, and 31 SP). No significant differences between preparations were observed in quality or high-quality total BBPS or high-quality segmental BBPS. Complete intake of the solution was higher for SP (p = 0.006) and lower for 1L-PEG (p = 0.02) compared to 2L-PEG intake (p = 0.55). Clinically irrelevant hyponatremia was higher in the SP group (p < 0.0001). SP instructions were easier to understand from patient's point of view (p = 0.01). Willingness to retake was higher with SP (p < 0.0001) and less for 1L-PEG (p < 0.0001). No serious adverse events were reported.

Conclusions: We observed no differences in efficacy between low-volume preparations in patients with IBD. Complete intake was higher for SP and lower for 1L-PEG. SP and 2L-PEG instructions were better understood and graded, and SP was more likely to be retaken. Willingness to retake was lower for 1L-PEG. No serious adverse events were reported.

Summary: No differences in terms of efficacy were regarded in this clinical trial comparing low-volume preparations for colonoscopy in patients with IBD: however, Sodium Pisoculfate is better tolerated and accepted from patient's point of view. No serious adverse events were reported.