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Su1554 A Comparative Study of Low-Volume Bowel Preparation Methods for Colonoscopy; Sodium Picosulfate Versus PEG-ASC
Abstracts Table 1. Association Between Dietary Components and Bowel
Cleanliness Total BBPS Scores
Water (g) Total dietary fiber (g) Insolube fiber (g) Vegetable protein (g) Starch (g) Total grains (oz) Refined grains (oz)
Correlation Coefficient (r) 0.14 –0.27 –0.32 –0.11 –0.32 –0.24 –0.27
B-CLEAR Scores
P value
Correlation Coefficient
P value
0.23 !0.02 !0.004 0.35 !0.005 0.04 0.01
-0.32 0.20 0.23 0.22 0.28 0.28 0.30
!0.004 !0.08 !0.04 0.05 !0.02 !0.02 !0.008
g Z grams; oz Z ounce equivalents
and total and refined (but not whole) grains (B-CLEAR and BBPS). Fat intake was associated with BBPS and B-CLEAR segment scores in the right colon only (rZ0.23, pZ0.04 and rZ0.22, pZ0.05 respectively). Total caloric intake, total and animal protein, carbohydrates, and pectins did not correlate with bowel preparation quality. Too few patients consumed dairy, nuts or legumes to assess these dietary factors. Conclusions: Despite the provision of standardized, restrictive dietary instructions to patients, detailed nutritional analyses still provided information about specific dietary components and their association with bowel preparation quality. Such an approach might be useful for developing lessrestrictive dietary instructions while preserving adequacy of bowel cleanliness at colonoscopy. Our findings further validate the B-CLEAR as a novel research tool that may be superior to the BBPS as an instrument for research assessing the impact of diet on bowel preparation.
Su1553 A Meta-Analysis of Colon Cleansing With PEG Compared to Other Bowel Preparations Charles MéNard3, Alan N. Barkun*1,2, Myriam Martel1, Sophie Restellini4, Omar Kherad5 1 Gastroenterology, McGill University, The Montreal General Hospital, GI Division, Montreal, QC, Canada; 2Epidemiology and Biostatistics and Occupational Health, McGill University Health Center, McGill University, Montreal, QC, Canada; 3Medicine, University of Sherbrooke, Sherbrooke, QC, Canada; 4Internal Medicine and Rehabilitation and Geriatric, Geneva’s University Hospitals and University of Geneva, Geneva, Switzerland; 5Internal Medicine, Tour Hospital and University of Geneva, Geneva, Switzerland Introduction: Different regimens of colon preparation are available for colonoscopy, they primarily include polyethylene glycol (PEG), sodium phosphate (NaP), picosulfate (PICO) or oral sulfate solution (OSS). The objective of this meta-analysis is to evaluate the efficacy, safety and patient satisfaction of PEG versus any comparator, NaP, PICO, and OSS. Aims&Methods: Systematic searches were completed querying MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge from January 1980 to August 2013. All fully published randomized controlled trials with colon preparation for colonoscopy were included. Populations including pediatric, sole inpatients or sole IBD patients were excluded. The primary outcome measure was the efficacy (excellent/good) of colon cleansing. Secondary outcomes included side effects or complications, procedural outcomes and patient satisfaction. A meta-analysis was conducted with results reported as odd-ratios (OR) with 95% confidence intervals. Heterogeneity and publication bias were assessed and quantified. Results: From an initial 2366 citations, 74 trials fulfilled the inclusion criteria (18,025 patients). When PEG was compared to all types of colon preparations, it did not show a significant difference in efficacy; ORZ1.11 (0.93; 1.33). Willingness to repeat was lower in the PEG group ORZ0.39 (0.23; 0.66) as well was fainting or dizziness ORZ0.75 (0.57; 0.98). Forty-five trials included the comparison PEG versus NaP (11,197 patients); PEG did not show a difference in efficacy; ORZ0.98 (0.74; 1.30); willingness to repeat was significantly decreased; ORZ0.36 (0.22; 0.67) as well as fainting and dizziness ORZ0.65 (0.50; 0.85). Eleven trials included the comparison PEG versus PICO (3,097 patients). PEG did not show a difference in efficacy; ORZ1.08 (0.73; 1.59). Willingness to repeat was significantly decreased; ORZ0.11 (0.04; 0.30), as well as fainting or dizziness ORZ0.46 (0.30; 0.68). Abdominal cramps, insomnia and perianal irritation where increased 1.42 (1.05; 1.92), 2.41 (1.15; 5.03) and, 2.57 (1.27; 5.20) in the PEG group respectively. Two studies compared PEG to OSS. PEG was not different in efficacy; ORZ0.90 (0.62; 1.30). Lack of data prevented the willingness to repeat analysis. Conclusion: PEG provides similar bowel cleansing efficacy to different types of colon preparations. Willingness to repeat was significantly lower with PEG when compared to all types of preparation wen the data was available. With PEG, more patients reported abdominal cramps compared to NaP, increased insomnia and perianal irritation compared to PICO headaches but less experienced fainting or dizziness compared to all types of preparations, NaP, and PICO.
AB212 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014
Su1554 A Comparative Study of Low-Volume Bowel Preparation Methods for Colonoscopy; Sodium Picosulfate Versus PEG-ASC Jong Soo Lee, Yoon Tae Jeen*, Seung Han Kim, Jae MIN Lee, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Hongsik Lee, Hoon Jai Chun, Chang Duck Kim, Seung Joo Nam Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea Background and Aim: Low-volume bowel preparations have been shown to provide an equivalent cleansing with improved tolerability as compared to standard 4L-PEG bowel preparation for colonoscopy. But, the study on superiority between low-volume bowel preparation methods are lacking. The aim of this study was to compare split-dose methods of Sodium Picosulfate/ Magnesium Citrate (SPMC) and Polyethylene Glycol with ascorbic acid (PEGAsc) in the aspect of bowel preparation quality and compliance. Methods: Single center, randomized, observer-blinded study was performed from March 2013 to September 2013. Total 200 out-patients were prospectively enrolled and received colonoscopy using low-volume bowel preparation, split-dose method. The patients underwent strict diet restriction; not allowed to eat non-digestable food like fruits, vegetables, minor cereals for 3 days before procedure. We used the Boston Bowel Preparation Scale and Aronchick Bowel Preparation Scale for evaluation of bowel cleansing. And we compared Bubble scoring between two methods. To investigate the preference and compliance, a questionnaire was performed before colonoscopy. Results: One hundred patients received SPMC and 100 patients received PEG-Asc. There were no significant differences between 2 groups in the aspect of completion of preparation, cecal intubation time, success rate and overall preparation quality (Boston score: SPMC 6.791.98, PEG-Asc 6.571.37, adequate preparation: SPMC 93%, PET-Asc 96%). In consideration of better preparation quality, the SMPC group showed superior cleansing results over the PEG-Asc group (8-9 Boston scale score: SMPC 44% vs PETG-Asc 26%, pZ0.003, Excellent Aronchick grade: SPMC 31% vs PEG-Asc 17%, pZ0.022). But, 3 cases in SMPC group showed severely inadequate preparation quality and they needed additional preparation. In the doctor discomfort aspect, dryness of mucosa is more in the SPMC group (9% vs 1%, PZ0.039) and slippery is more in the PEG+Asc (2% vs 10%, pZ0.041). Some gastrointestinal symptoms (abdominal fullness, general discomfort) were less and taste of solution were better in SPMC group compared to PEG-Asc group (p!0.05). Conclusions: Both PEG-Asc and SPMC showed good preparation quality and good compliance for colonoscopy bowel preparation. But SPMC had better tolerability compared with PEG-Asc.
Su1555 A Validation Study of 4 Types Bowel Cleasing Scale : Aronchick Scale, Boston Bowel Preparation Scale, Ottawa Scale, Harefield Cleasing Scale Seung Han Kim, Jong Soo Lee, Jae MIN Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yoon Tae Jeen, Hongsik Lee*, Hoon Jai Chun, Chang Duck Kim Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea Background / Aims: Total colonoscopy is a potent tool for assessing the large bowel. A colonoscopy report should include an assessment of bowel cleansing. Quality measure is necessary to judge the reliability of the findings. There are various bowel preparation scale, but few bowel preparation scale have been validated. Diversity in bowel preperation scales can cause a lot of confusion on decisions in clinical environment and much confounding results within clinical studies. However, there have been no clinical trial that compared 4 types of bowel preparation scales. The aim of this study is to assess the compatibility and reliability of different 4 types of bowel preparation scales. Methods: Total 20 patients underwent colonoscopy for screening or diagnostic purposes between May 2013 to July 2013. Patients with documented carcinoma, severe morbidity were excluded. 5 trainees read 20 total colonoscopy studies twice, with an interval of 1 month. This study compared 4 types of bowel preparation scales: Aronchick scale(AC), Boston bowel preparation scale(BBPS), Ottawa scale(OS), Harefield cleansing scale(HCS). We used Intraclass correlation coefficient(ICC) to evaluate Intra-observer(test-retest) consistency and interobserver reliability of the BBPS and the OS. The unweighted kappa statistic was used to assess the reliability of the AC and the HCS. Results :Inter-observer scores for OS, ICC was 0.73 (95% CI, 0.52-0.87, p ! 0.0001), BBPS 0.76 (95% CI, 0.590.88, p ! 0.0001), inter-observer kappa for AC was 0.29 (95% CI, 0.19-0.42, p ! 0.0001), HCS 0.27 (95% CI, 0.15-0.41, p ! 0.0001). Intra-observer scores for OS, ICC was 0.79-0.96, BBPS, 0.73-0.89. Intra-observer kappa for AC was 0.51-0.79 and for HCS, 0.36-0.92. Conclusions: Inter-observer and intra-observer agreement values were high in OS and BBPS. This validation analysis showed that OS and BBPS are reliable, coherent scales so that they can provide better standardization to evaluate bowel preparation in both study and clinical practice.
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Cleanliness Total BBPS Scores
Water (g) Total dietary fiber (g) Insolube fiber (g) Vegetable protein (g) Starch (g) Total grains (oz) Refined grains (oz)
Correlation Coefficient (r) 0.14 –0.27 –0.32 –0.11 –0.32 –0.24 –0.27
B-CLEAR Scores
P value
Correlation Coefficient
P value
0.23 !0.02 !0.004 0.35 !0.005 0.04 0.01
-0.32 0.20 0.23 0.22 0.28 0.28 0.30
!0.004 !0.08 !0.04 0.05 !0.02 !0.02 !0.008
g Z grams; oz Z ounce equivalents
and total and refined (but not whole) grains (B-CLEAR and BBPS). Fat intake was associated with BBPS and B-CLEAR segment scores in the right colon only (rZ0.23, pZ0.04 and rZ0.22, pZ0.05 respectively). Total caloric intake, total and animal protein, carbohydrates, and pectins did not correlate with bowel preparation quality. Too few patients consumed dairy, nuts or legumes to assess these dietary factors. Conclusions: Despite the provision of standardized, restrictive dietary instructions to patients, detailed nutritional analyses still provided information about specific dietary components and their association with bowel preparation quality. Such an approach might be useful for developing lessrestrictive dietary instructions while preserving adequacy of bowel cleanliness at colonoscopy. Our findings further validate the B-CLEAR as a novel research tool that may be superior to the BBPS as an instrument for research assessing the impact of diet on bowel preparation.
Su1553 A Meta-Analysis of Colon Cleansing With PEG Compared to Other Bowel Preparations Charles MéNard3, Alan N. Barkun*1,2, Myriam Martel1, Sophie Restellini4, Omar Kherad5 1 Gastroenterology, McGill University, The Montreal General Hospital, GI Division, Montreal, QC, Canada; 2Epidemiology and Biostatistics and Occupational Health, McGill University Health Center, McGill University, Montreal, QC, Canada; 3Medicine, University of Sherbrooke, Sherbrooke, QC, Canada; 4Internal Medicine and Rehabilitation and Geriatric, Geneva’s University Hospitals and University of Geneva, Geneva, Switzerland; 5Internal Medicine, Tour Hospital and University of Geneva, Geneva, Switzerland Introduction: Different regimens of colon preparation are available for colonoscopy, they primarily include polyethylene glycol (PEG), sodium phosphate (NaP), picosulfate (PICO) or oral sulfate solution (OSS). The objective of this meta-analysis is to evaluate the efficacy, safety and patient satisfaction of PEG versus any comparator, NaP, PICO, and OSS. Aims&Methods: Systematic searches were completed querying MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge from January 1980 to August 2013. All fully published randomized controlled trials with colon preparation for colonoscopy were included. Populations including pediatric, sole inpatients or sole IBD patients were excluded. The primary outcome measure was the efficacy (excellent/good) of colon cleansing. Secondary outcomes included side effects or complications, procedural outcomes and patient satisfaction. A meta-analysis was conducted with results reported as odd-ratios (OR) with 95% confidence intervals. Heterogeneity and publication bias were assessed and quantified. Results: From an initial 2366 citations, 74 trials fulfilled the inclusion criteria (18,025 patients). When PEG was compared to all types of colon preparations, it did not show a significant difference in efficacy; ORZ1.11 (0.93; 1.33). Willingness to repeat was lower in the PEG group ORZ0.39 (0.23; 0.66) as well was fainting or dizziness ORZ0.75 (0.57; 0.98). Forty-five trials included the comparison PEG versus NaP (11,197 patients); PEG did not show a difference in efficacy; ORZ0.98 (0.74; 1.30); willingness to repeat was significantly decreased; ORZ0.36 (0.22; 0.67) as well as fainting and dizziness ORZ0.65 (0.50; 0.85). Eleven trials included the comparison PEG versus PICO (3,097 patients). PEG did not show a difference in efficacy; ORZ1.08 (0.73; 1.59). Willingness to repeat was significantly decreased; ORZ0.11 (0.04; 0.30), as well as fainting or dizziness ORZ0.46 (0.30; 0.68). Abdominal cramps, insomnia and perianal irritation where increased 1.42 (1.05; 1.92), 2.41 (1.15; 5.03) and, 2.57 (1.27; 5.20) in the PEG group respectively. Two studies compared PEG to OSS. PEG was not different in efficacy; ORZ0.90 (0.62; 1.30). Lack of data prevented the willingness to repeat analysis. Conclusion: PEG provides similar bowel cleansing efficacy to different types of colon preparations. Willingness to repeat was significantly lower with PEG when compared to all types of preparation wen the data was available. With PEG, more patients reported abdominal cramps compared to NaP, increased insomnia and perianal irritation compared to PICO headaches but less experienced fainting or dizziness compared to all types of preparations, NaP, and PICO.
AB212 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014
Su1554 A Comparative Study of Low-Volume Bowel Preparation Methods for Colonoscopy; Sodium Picosulfate Versus PEG-ASC Jong Soo Lee, Yoon Tae Jeen*, Seung Han Kim, Jae MIN Lee, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Hongsik Lee, Hoon Jai Chun, Chang Duck Kim, Seung Joo Nam Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea Background and Aim: Low-volume bowel preparations have been shown to provide an equivalent cleansing with improved tolerability as compared to standard 4L-PEG bowel preparation for colonoscopy. But, the study on superiority between low-volume bowel preparation methods are lacking. The aim of this study was to compare split-dose methods of Sodium Picosulfate/ Magnesium Citrate (SPMC) and Polyethylene Glycol with ascorbic acid (PEGAsc) in the aspect of bowel preparation quality and compliance. Methods: Single center, randomized, observer-blinded study was performed from March 2013 to September 2013. Total 200 out-patients were prospectively enrolled and received colonoscopy using low-volume bowel preparation, split-dose method. The patients underwent strict diet restriction; not allowed to eat non-digestable food like fruits, vegetables, minor cereals for 3 days before procedure. We used the Boston Bowel Preparation Scale and Aronchick Bowel Preparation Scale for evaluation of bowel cleansing. And we compared Bubble scoring between two methods. To investigate the preference and compliance, a questionnaire was performed before colonoscopy. Results: One hundred patients received SPMC and 100 patients received PEG-Asc. There were no significant differences between 2 groups in the aspect of completion of preparation, cecal intubation time, success rate and overall preparation quality (Boston score: SPMC 6.791.98, PEG-Asc 6.571.37, adequate preparation: SPMC 93%, PET-Asc 96%). In consideration of better preparation quality, the SMPC group showed superior cleansing results over the PEG-Asc group (8-9 Boston scale score: SMPC 44% vs PETG-Asc 26%, pZ0.003, Excellent Aronchick grade: SPMC 31% vs PEG-Asc 17%, pZ0.022). But, 3 cases in SMPC group showed severely inadequate preparation quality and they needed additional preparation. In the doctor discomfort aspect, dryness of mucosa is more in the SPMC group (9% vs 1%, PZ0.039) and slippery is more in the PEG+Asc (2% vs 10%, pZ0.041). Some gastrointestinal symptoms (abdominal fullness, general discomfort) were less and taste of solution were better in SPMC group compared to PEG-Asc group (p!0.05). Conclusions: Both PEG-Asc and SPMC showed good preparation quality and good compliance for colonoscopy bowel preparation. But SPMC had better tolerability compared with PEG-Asc.
Su1555 A Validation Study of 4 Types Bowel Cleasing Scale : Aronchick Scale, Boston Bowel Preparation Scale, Ottawa Scale, Harefield Cleasing Scale Seung Han Kim, Jong Soo Lee, Jae MIN Lee, Seung Joo Nam, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yoon Tae Jeen, Hongsik Lee*, Hoon Jai Chun, Chang Duck Kim Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea Background / Aims: Total colonoscopy is a potent tool for assessing the large bowel. A colonoscopy report should include an assessment of bowel cleansing. Quality measure is necessary to judge the reliability of the findings. There are various bowel preparation scale, but few bowel preparation scale have been validated. Diversity in bowel preperation scales can cause a lot of confusion on decisions in clinical environment and much confounding results within clinical studies. However, there have been no clinical trial that compared 4 types of bowel preparation scales. The aim of this study is to assess the compatibility and reliability of different 4 types of bowel preparation scales. Methods: Total 20 patients underwent colonoscopy for screening or diagnostic purposes between May 2013 to July 2013. Patients with documented carcinoma, severe morbidity were excluded. 5 trainees read 20 total colonoscopy studies twice, with an interval of 1 month. This study compared 4 types of bowel preparation scales: Aronchick scale(AC), Boston bowel preparation scale(BBPS), Ottawa scale(OS), Harefield cleansing scale(HCS). We used Intraclass correlation coefficient(ICC) to evaluate Intra-observer(test-retest) consistency and interobserver reliability of the BBPS and the OS. The unweighted kappa statistic was used to assess the reliability of the AC and the HCS. Results :Inter-observer scores for OS, ICC was 0.73 (95% CI, 0.52-0.87, p ! 0.0001), BBPS 0.76 (95% CI, 0.590.88, p ! 0.0001), inter-observer kappa for AC was 0.29 (95% CI, 0.19-0.42, p ! 0.0001), HCS 0.27 (95% CI, 0.15-0.41, p ! 0.0001). Intra-observer scores for OS, ICC was 0.79-0.96, BBPS, 0.73-0.89. Intra-observer kappa for AC was 0.51-0.79 and for HCS, 0.36-0.92. Conclusions: Inter-observer and intra-observer agreement values were high in OS and BBPS. This validation analysis showed that OS and BBPS are reliable, coherent scales so that they can provide better standardization to evaluate bowel preparation in both study and clinical practice.
www.giejournal.org