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Picosulfate in Single or Split Dosing for Colonoscopy Preparation: a Multicenter Randomized Trial
Abstracts Pilot Colon Preparation Results Using Physician Assessment for Colonoscopy Preparation Assessment Patient number 1 2 3 4 5 6 7 8 9 10
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Global Assessment
Good Good Fair Good Good Fair Good Good Fair Good
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Good Excellent Excellent Good Good Good Excellent Excellent Good Excellent
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Excellent Z No more than small bits of adherent feces/fluid. Good Z Large volume, clear to semiclear liquid. Fair Z Colored liquid or semisolid stool, suctioned. Poor Z Semisolid or solid stool, unable to suction. Source for physician assessment: DiPalma 2009.
Su1526 Improving Bowel Preparation Quality by Using Simethicone With Polyethylene Glycol Plus Ascorbic Acid Yoon Tae Jeen*, in Kyung Yoo, Hoon Jai Chun, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Hongsik Lee, Chang Duck Kim, Ho Sang Ryu, Ja Seol Koo Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea (the Republic of) Background and Aim: Low-volume PEG-Asc has been proved to be similarly safe and effective as traditional 4 L PEG. However, PEG-Asc produce lots of bubble and endoscopists feel discomfort during colonoscopy. The study on adding antiforming agent such as simethicone with PEG-Asc methods are lacking. The aim of this study was to compare PEG-Asc and PEG-Asc with simethicone in the aspect of bowel preparation quality and compliance of endoscopist. Methods: Single center, randomized, observer-blinded study was performed from July 2014 to September 2014. Total 200 out-patients were prospectively enrolled. We used the Boston Bowel Preparation Scale and Bubble score for evaluation of bowel cleansing. To investigate the compliance of endoscopists, a questionnaire for water shooting count and withdrawal time was performed. Also, patients completed questionnaires about the symptoms associated with the preparations to assess their tolerability before the colonoscopy. Results: One hundred patients received PEG-Asc and 100 patients received PEG-Asc with simethicone. There were no significant differences between 2 groups in the aspect of completion of preparation, cecal intubation time, success rate and overall preparation quality. In consideration of better preparation quality, the PEG-Asc with simethicone group showed superior cleansing results over the PEG-Asc group (6-9 Boston scale score: 100% vs 84%, 3 bubble score: 95% vs 54%, p!0.05). From the perspective of practitioners, PEG-Asc with simethicone group was less suffer from bubble which disturbed the lens. The mean count of water shooting for cleansing lens was significantly lower and withdrawal time of colonoscope was less in PEG-Asc with simethicone group compared to PEG-Asc group (1 vs. 10, 15.02 10.10 vs. 17.8314.80min, p!0.05). PEG-Asc with simethicone caused fewer gastrointestinal symptoms (ex. abdominal fullness, colicky pain, general discomfort) than PEG-Asc. Conclusions: According to our data, PEG-Asc plus simethicone has comparably effective and better tolerable for patient and endoscopist. Therefore, a combination of PEG and simethicone appears to be a standard method for bowel preparation.
Su1527 Efficacy and Tolerance of Low-Volume Polyethylene Glycol/ Ascorbic Acid and Magnesium Citrate/Picosulfate in Single or Split Dosing for Colonoscopy Preparation: a Multicenter Randomized Trial Vladimir Kojecky*1, Jiri Dolina2, Milan Dastych2, Miroslav Misurec1, Michal Varga1, Jiri Latta1, Ales Hep2, Bohuslav Kianicka3 1 Internal Clinic, Bata Regional Hospital, Bata Regional Hospital, Zlin, Czech Republic; 2Dept. of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic; 33 2nd Clinic of Internal Medicine, Department of Gastroenterology, St’. Anne’s University Hospital, Brno, Czech Republic Background: Quality of the bowel preparation and acceptability of the preparation is a key factor in the success of the colonoscopy. Standard large volume PEG is poorly tolerated. New combined formulas have been introduced. Not enough data directly
AB316 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
comparing these preparations are available. Aim of the study was to compare efficacy and acceptability of a 2L polyethylene glycol/ascorbic acid solution (PEGA) with a picosulfate/ Mg citrate (PMC) in single or split dosing. Methods: A prospective, randomized, endoscopist-blinded, multicenter study. The patients were assigned to receive 4L PMC (PMC4/0) or 2L PEGA (PEGA2/0) in a single dose day before colonoscopy or a split dose of 2+2L PMC (PMC2/2) or 1+1L PEGA (PEGA1/1) one day before and in the morning before the colonoscopy. Each patient was interviewed to determine tolerance of the preparation before the procedure. The quality of bowel cleansing was assessed blindly by multiple endoscopists using the Aronchick scale and interval between last dose of the preparation and start of the colonoscopy was recorded. Results: A total of 315 ( 85 randomized per branch) subjects were enrolled. Satisfactory bowel cleansing (Aronchick score 1 and 2) was significantly more frequent when a split dose was used irrespective of the solution type (84.6 % PMC2/2, 87.7% PEGA1/1 vs 65.0% PMC4/0, 64.5% PEGA2/0, p! 0.019). Quality of the preparation inversely correlated with delay of the colonoscopy (p! 0.005).A PMC based solution was generally better tolerated (tolerance 1-2) than PEGA regardless of the regimen used (87.5% PMC4/0, 92.0 % PMC2/2 vs 52.8% PEGA2/0, 56.8% PEGA1/ 1, p!0.001). Nausea was reported mostly after the PEGA2/0 (26.3%, p ! 0.001), bloating after the PMC2/2 (33.3%, p ! 0.04). There was no significant difference in the prevalence of vomiting, abdominal pain and incontinence during preparation. Conclusion: Quality of the colonic cleansing with PMC or PEGA is comparable, in case of similar preparation regimen. Split dosing improves colonic cleansing. PMC is generally better tolerated than PGA, regardless of regimen used.
Su1528 Practice Patterns in the Use of Bowel Preparation Regimens During Colonoscopy Among Gastroenterologists in the US: Results From a National Survey Sumalatha Muthineni*3,1, Diego Lim3,1, Prashanth Vennalaganti3, Neil Gupta2, Sravanthi Parasa3,4, Mohammad A. Titi3,4, Abhishek Choudhary3,4, Ajay Bansal3,4, Alessandro Repici5, Cesare Hassan6, Prateek Sharma3,4 1 Department of Internal Medicine, University of Kansas School of Medicine, Kansas, KS; 2Department of Gastroenterology, Loyola University Medical Center, Maywood, IL; 3Department of Gastroenterology/Hepatology, Veteran Affairs Medical Center, Kansas, MO; 4Department of Gastroenterology/Hepatology, University of Kansas School of Medicine, Kansas, MO; 5Digestive Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy; 6Department of Gastroenterology, Nuovo Regina Margherita Hospital, Milan, Italy Background: Split-dose bowel preparation regimens are recommended for colonoscopy by the majority of the gastroenterological societies. Aim: To understand the prevalence of various types of bowel preparations utilized during screening and surveillance colonoscopy among gastroenterologists in the US and predictors of their usage. Methods: A survey of practicing gastroenterologists in the United States was conducted by distributing a 2-page questionnaire during 3 national GI meetings. The survey contained a total of 18 questions pertaining to physician demographics (age, years in practice, gender), colonoscopy volume (!20 vs. O20 per week), practice setting (academic vs. community), endoscopy unit type (hospital based vs. other), use of types of bowel preparation (split vs. non-split prep), use of advanced technology/techniques during colonoscopy and documentation of quality indicators (ADR and colonoscopy withdrawal time) during their performance of screening and surveillance colonoscopy. Tests of significance for all categorical variables were performed using chi2 test. Multivariate logistic regression methods were used for prediction of usage of type of bowel preparation. All covariates for multivariate analysis were chosen apriori based on existing literature. Those who had provided incomplete information were excluded from the study. Results: A total of 500 questionnaires were distributed and 228 respondents completed the survey (response rate 45.6%); 7 were excluded due to incomplete information. The majority of the respondents (184/221; 83.3%) reported using split-dose preparation for colonoscopy preparation routinely whereas the remainder (16.7%) reported using non-split bowel preparations. (Table 1) Patient preference (27%), endoscopy unit limitations (18.9%) and staffing issues (10.8%) were cited as common reasons for using non-split bowel preparation. On uni-variate analysis, the use of split-dose preparation was significantly higher among those gastroenterologists performing R20 colonoscopies/week (90% vs. 77.6%, p 0.013), practicing in non-academic settings vs. academic settings (85.4% vs. 71.4%, p 0.04) and non-hospital based endoscopy units (example: ambulatory surgical centers) vs. hospital based (87.6% vs. 78%, p 0.057). On multivariate analysis, practicing physicians between 41-50 years of age (OR 0.16 (0.03-0.92), p 0.04) was the only independent predictor for the use of split bowel prep, when adjusted for other gender, years of practice, practice setting, colonoscopy volume and endoscopy unit type. (Table 2). Conclusion: The majority of gastroenterologists (83%) who participated in this survey reported the use of split-dose bowel preparation for screening and surveillance colonoscopy. Patient preference, endoscopy unit limitations and staffing issues were cited as common reasons for using non-split bowel preparation
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Ascending
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Descending
Global Assessment
Good Good Fair Good Good Fair Good Good Fair Good
Excellent Excellent Excellent Good Excellent Good Good Good Good Good
Good Excellent Excellent Good Good Good Excellent Excellent Good Excellent
Good Excellent Good Good Good Good Good Good Good Good
Excellent Z No more than small bits of adherent feces/fluid. Good Z Large volume, clear to semiclear liquid. Fair Z Colored liquid or semisolid stool, suctioned. Poor Z Semisolid or solid stool, unable to suction. Source for physician assessment: DiPalma 2009.
Su1526 Improving Bowel Preparation Quality by Using Simethicone With Polyethylene Glycol Plus Ascorbic Acid Yoon Tae Jeen*, in Kyung Yoo, Hoon Jai Chun, Bora Keum, Eun Sun Kim, Hyuk Soon Choi, Hongsik Lee, Chang Duck Kim, Ho Sang Ryu, Ja Seol Koo Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea (the Republic of) Background and Aim: Low-volume PEG-Asc has been proved to be similarly safe and effective as traditional 4 L PEG. However, PEG-Asc produce lots of bubble and endoscopists feel discomfort during colonoscopy. The study on adding antiforming agent such as simethicone with PEG-Asc methods are lacking. The aim of this study was to compare PEG-Asc and PEG-Asc with simethicone in the aspect of bowel preparation quality and compliance of endoscopist. Methods: Single center, randomized, observer-blinded study was performed from July 2014 to September 2014. Total 200 out-patients were prospectively enrolled. We used the Boston Bowel Preparation Scale and Bubble score for evaluation of bowel cleansing. To investigate the compliance of endoscopists, a questionnaire for water shooting count and withdrawal time was performed. Also, patients completed questionnaires about the symptoms associated with the preparations to assess their tolerability before the colonoscopy. Results: One hundred patients received PEG-Asc and 100 patients received PEG-Asc with simethicone. There were no significant differences between 2 groups in the aspect of completion of preparation, cecal intubation time, success rate and overall preparation quality. In consideration of better preparation quality, the PEG-Asc with simethicone group showed superior cleansing results over the PEG-Asc group (6-9 Boston scale score: 100% vs 84%, 3 bubble score: 95% vs 54%, p!0.05). From the perspective of practitioners, PEG-Asc with simethicone group was less suffer from bubble which disturbed the lens. The mean count of water shooting for cleansing lens was significantly lower and withdrawal time of colonoscope was less in PEG-Asc with simethicone group compared to PEG-Asc group (1 vs. 10, 15.02 10.10 vs. 17.8314.80min, p!0.05). PEG-Asc with simethicone caused fewer gastrointestinal symptoms (ex. abdominal fullness, colicky pain, general discomfort) than PEG-Asc. Conclusions: According to our data, PEG-Asc plus simethicone has comparably effective and better tolerable for patient and endoscopist. Therefore, a combination of PEG and simethicone appears to be a standard method for bowel preparation.
Su1527 Efficacy and Tolerance of Low-Volume Polyethylene Glycol/ Ascorbic Acid and Magnesium Citrate/Picosulfate in Single or Split Dosing for Colonoscopy Preparation: a Multicenter Randomized Trial Vladimir Kojecky*1, Jiri Dolina2, Milan Dastych2, Miroslav Misurec1, Michal Varga1, Jiri Latta1, Ales Hep2, Bohuslav Kianicka3 1 Internal Clinic, Bata Regional Hospital, Bata Regional Hospital, Zlin, Czech Republic; 2Dept. of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic; 33 2nd Clinic of Internal Medicine, Department of Gastroenterology, St’. Anne’s University Hospital, Brno, Czech Republic Background: Quality of the bowel preparation and acceptability of the preparation is a key factor in the success of the colonoscopy. Standard large volume PEG is poorly tolerated. New combined formulas have been introduced. Not enough data directly
AB316 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
comparing these preparations are available. Aim of the study was to compare efficacy and acceptability of a 2L polyethylene glycol/ascorbic acid solution (PEGA) with a picosulfate/ Mg citrate (PMC) in single or split dosing. Methods: A prospective, randomized, endoscopist-blinded, multicenter study. The patients were assigned to receive 4L PMC (PMC4/0) or 2L PEGA (PEGA2/0) in a single dose day before colonoscopy or a split dose of 2+2L PMC (PMC2/2) or 1+1L PEGA (PEGA1/1) one day before and in the morning before the colonoscopy. Each patient was interviewed to determine tolerance of the preparation before the procedure. The quality of bowel cleansing was assessed blindly by multiple endoscopists using the Aronchick scale and interval between last dose of the preparation and start of the colonoscopy was recorded. Results: A total of 315 ( 85 randomized per branch) subjects were enrolled. Satisfactory bowel cleansing (Aronchick score 1 and 2) was significantly more frequent when a split dose was used irrespective of the solution type (84.6 % PMC2/2, 87.7% PEGA1/1 vs 65.0% PMC4/0, 64.5% PEGA2/0, p! 0.019). Quality of the preparation inversely correlated with delay of the colonoscopy (p! 0.005).A PMC based solution was generally better tolerated (tolerance 1-2) than PEGA regardless of the regimen used (87.5% PMC4/0, 92.0 % PMC2/2 vs 52.8% PEGA2/0, 56.8% PEGA1/ 1, p!0.001). Nausea was reported mostly after the PEGA2/0 (26.3%, p ! 0.001), bloating after the PMC2/2 (33.3%, p ! 0.04). There was no significant difference in the prevalence of vomiting, abdominal pain and incontinence during preparation. Conclusion: Quality of the colonic cleansing with PMC or PEGA is comparable, in case of similar preparation regimen. Split dosing improves colonic cleansing. PMC is generally better tolerated than PGA, regardless of regimen used.
Su1528 Practice Patterns in the Use of Bowel Preparation Regimens During Colonoscopy Among Gastroenterologists in the US: Results From a National Survey Sumalatha Muthineni*3,1, Diego Lim3,1, Prashanth Vennalaganti3, Neil Gupta2, Sravanthi Parasa3,4, Mohammad A. Titi3,4, Abhishek Choudhary3,4, Ajay Bansal3,4, Alessandro Repici5, Cesare Hassan6, Prateek Sharma3,4 1 Department of Internal Medicine, University of Kansas School of Medicine, Kansas, KS; 2Department of Gastroenterology, Loyola University Medical Center, Maywood, IL; 3Department of Gastroenterology/Hepatology, Veteran Affairs Medical Center, Kansas, MO; 4Department of Gastroenterology/Hepatology, University of Kansas School of Medicine, Kansas, MO; 5Digestive Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy; 6Department of Gastroenterology, Nuovo Regina Margherita Hospital, Milan, Italy Background: Split-dose bowel preparation regimens are recommended for colonoscopy by the majority of the gastroenterological societies. Aim: To understand the prevalence of various types of bowel preparations utilized during screening and surveillance colonoscopy among gastroenterologists in the US and predictors of their usage. Methods: A survey of practicing gastroenterologists in the United States was conducted by distributing a 2-page questionnaire during 3 national GI meetings. The survey contained a total of 18 questions pertaining to physician demographics (age, years in practice, gender), colonoscopy volume (!20 vs. O20 per week), practice setting (academic vs. community), endoscopy unit type (hospital based vs. other), use of types of bowel preparation (split vs. non-split prep), use of advanced technology/techniques during colonoscopy and documentation of quality indicators (ADR and colonoscopy withdrawal time) during their performance of screening and surveillance colonoscopy. Tests of significance for all categorical variables were performed using chi2 test. Multivariate logistic regression methods were used for prediction of usage of type of bowel preparation. All covariates for multivariate analysis were chosen apriori based on existing literature. Those who had provided incomplete information were excluded from the study. Results: A total of 500 questionnaires were distributed and 228 respondents completed the survey (response rate 45.6%); 7 were excluded due to incomplete information. The majority of the respondents (184/221; 83.3%) reported using split-dose preparation for colonoscopy preparation routinely whereas the remainder (16.7%) reported using non-split bowel preparations. (Table 1) Patient preference (27%), endoscopy unit limitations (18.9%) and staffing issues (10.8%) were cited as common reasons for using non-split bowel preparation. On uni-variate analysis, the use of split-dose preparation was significantly higher among those gastroenterologists performing R20 colonoscopies/week (90% vs. 77.6%, p 0.013), practicing in non-academic settings vs. academic settings (85.4% vs. 71.4%, p 0.04) and non-hospital based endoscopy units (example: ambulatory surgical centers) vs. hospital based (87.6% vs. 78%, p 0.057). On multivariate analysis, practicing physicians between 41-50 years of age (OR 0.16 (0.03-0.92), p 0.04) was the only independent predictor for the use of split bowel prep, when adjusted for other gender, years of practice, practice setting, colonoscopy volume and endoscopy unit type. (Table 2). Conclusion: The majority of gastroenterologists (83%) who participated in this survey reported the use of split-dose bowel preparation for screening and surveillance colonoscopy. Patient preference, endoscopy unit limitations and staffing issues were cited as common reasons for using non-split bowel preparation
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