Efficacy, tolerability and safety of low volume bowel preparations in Inflammatory Bowel Diseases: The French multicentre CLEAN study

Briot C1, Faure P2, Parmentier AL3, Nachury M4, Trang C5, Viennot S6, Altwegg R7, Bulois P8, Thomassin L9, Serrero M10, Ah-Soune P11, Gilletta C12, Plastaras L13, Simon M14, Dray X15, Caillo L16, Del Tedesco E17, Abitbol V18, Zallot C19, Degand T20, Rossi V21, Bonnaud G22, Colin D23, Morel B24, Winkfield B25, Danset JB26, Filippi J27, Amiot A28, Attar A29, Levy J30, Peyrin-Biroulet L19, Vuitton L1; CLEAN study group. J Crohns Colitis. 2019 Feb 13. pii: jjz040. doi: 10.1093/ecco-jcc/jjz040. [Epub ahead of print]


Author information

1 Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France.

2 Clinique Pasteur, Toulouse, France.

3 Centre de Méthodologie Clinique, University Hospital of Besançon, Besançon, France.

4 Gastroenterology Department, University Hospital of Lille, Lille, France.

5 Department of Hepatology and Gastroenterology, University Hospital Hotel Dieu, Nantes, France.

6 Gastroenterology Department, University Hospital of Caen, Caen, France.

7 Department of Hepatology and Gastroenterology, University Hospital of St Eloi, Montpellier, France.

8 Hôpital Privé la Louvière, Ramsay Générale de Santé, Lille France.

9 Department of Gastroenterology, University Hospital Charles Nicolle, Rouen, France.

10 Department of Gastroenterology, APHM, Hopital Nord, Marseille, France.

11 Department of Hepatology and Gastroenterology, Toulon - La Seyne-sur-Mer Hospital, Toulon, France.

12 Department of Gastroenterology, University Hospital Rangueuil, Toulouse, France.

13 Department of Hepato-Gastroenterology, Hospital Pasteur, Colmar, France.

14 Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France.

15 Department of Gastroenterology, Sorbonne University & APHP, Hôpital Saint-Antoine, Paris, France.

16 Department of Gastroenterology and Hepatology, University Hospital Caremeau, Nimes, France.

17 Department of Gastroenterology, University hospital of Saint-Etienne, Saint Priest en Jarez, France.

18 Department of Gastroenterology, University Hospital Cochin, Paris, France.

19 Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France.

20 Department of Gastroenterology, University Hospital Le Bocage, Dijon, France.

21 Department of Gastroenterology, Hospital Haut Anjou, Château Gontier, France.

22 Clinique Ambroise Paré, Toulouse, France.

23 Clinique de la Miotte, Belfort, France.

24 Department of Gastroenterology, Centre Hospitalier de Villefranche-sur-Saône, Gleizé, France.

25 Department of Hepatology and Gastroenterology, Hôpital Nord Franche-Comté, Trevenans, France.

26 Department of HepatoGastroenterology, European Georges-Pompidou Hospital, APHP, Paris, France.

27 Department of Gastroenterology, University Hospital L'Archet, Nice, France.

28 Department of Gastroenterology, Henri Mondor Hospital, APHP, Paris Est-Créteil, Creteil, France.

29 Gastroenterology department- Beaujon University Hospital, CLICHY.

30 Clinique des Cèdres, Cornebarrieu, France.


BACKGROUND: Standard high-volume polyethylene glycol (PEG) bowel preparations (PEG-4L) are recommended in inflammatorybowel disease (IBD) patients for colonoscopy. However, low-volume preparations (≤ 2 L of active volume) are often used in clinical practice. The aim of the study was to evaluate efficacy, tolerability and safety of the various bowel preparations in IBD, including low-volume preparations.

METHODS: We conducted a French prospective multicentre observational study, during one month. Patients aged 18-75 years with IBD with an indication of colonoscopy independent from the study were enrolled. The choice of the preparation was left to the investigators as per their usual protocol. Patients, disease and colonoscopy characteristics were recorded, patients were given self-reported questionnaires.

RESULTS: Twenty-five public and private hospitals enrolled 278 patients. Among them, 46 had a disease flare and 41 had bowelstenoses. 42% received PEG-2L, 29% sodium picosulfate (Pico), 15% PEG-4L, and 14% had other preparations. The preparation did not reach the Boston's score efficacy outcome in the PEG-4L group in 51.2% of the patients (p=0.0011). The preparation intake was complete for 59.5% in the PEG-4L group compared to 82.9% in the PEG-2L group and 93.8% in the Pico group (p<0.0001). Tolerability assessed by patients' VAS was significantly better with both Pico and PEG-2L compared to PEG-4L, and better with Pico compared to PEG-2L (p=0.008; p=0.0003). In multivariate analyses, low volume preparations were independent factors of efficacy and tolerability. Adverse events occurred in 4.3% of the patients.

CONCLUSIONS: Preparations with PEG-2L and Pico were equally safe, with better efficacy and tolerability outcomes compared with PEG-4L preparations. The best efficacy/tolerance/safety profile was achieved with the Pico preparation.

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