A Prospective Study Of The Enhanced Regimen For Patients With Colorectal Surgery In Bowel Preparation Before Colonoscopy

Background and objectiveThe incidence and mortality rate of colorectal cancer are both increasing.Colonoscopy is recognized as a standard method in the diagnosing and monitoring for colorectal cancer and other colorectal lesions,which can detect and remove colonic polyps or adenoma in the early stage to reduce the risk of colorectal cancer.The success of colonoscopy strongly depends on adequate bowel preparation(BP).Unsuccessful bowel preparation could lead to negative consequences,including significantly reduction of adenomas detection rate,reduced insertion rate of cecum,increased procedural difficulties and incidence of operation-related complications.Up to date,polyethylene glycol(PEG)electrolyte solution is the most commonly used cathartic in the bowel preparation because of its higher safety,efficiency,and patient tolerability in the bowel preparation.In Western countries,4-L PEG regimen for bowel cleansing is applied conventionally.Correspondingly,2-L PEG is recommended in Asian countries,possibly because Asian population has the smaller body size,lower body weight,different diet habits and poorer tolerance.Colorectal surgery has been proved to be a risk factor of inadequate bowel preparation.Besides,2-L PEG regimen was not satisfactory for patients with colorectal surgery in the clinical practice.The dose of PEG is a key factor which affects the preparation quality.Consequently we could apply the 4-L PEG regimen in such patients to improve the quality of BP.The aim of this study was to investigate the effect of the enhanced split-dose 4-L PEG regimen on the quality of BP in Asian patients with colorectal surgery.MethodsA single-center,prospective,endoscopist-blinded study was conducted.Patients with colorectal resection were randomized to receive either a routine morning-only,2-L(2-MO)or split-dose 4-L(4-SD)PEG for BP.Primary outcome was the rate of successful BP.All colonoscopies were performed between 13:30 to 17:00.Secondary outcomes included poly detection rate(PDR),adenoma detection rate(ADR),patient compliance,satisfaction,tolerability,willingness to repeat the preparation and the difficulty degree of performing BP.ResultsA total of 187 patients were randomized to 2-MO group(n=91)or 4-SD group(n=94).According to the Aronchick score,the rate of successful BP in 4-SD group is significantly higher than 2-MO group both in an intention-to-treat analysis(89.4%vs.66.7%,P<0.001)and per protocol analysis(91.2%vs.68.9%,P<0.001).The patient satisfaction of BP process in 4-SD group was superior to 2-MO group.PDR(59.6%vs.49.5%,P=0.125)and ADR(22.3%vs.12.9%,P=0.091)were slightly higher in 4-SD group than in 2-MO group.Besides,no significant difference was detected in patient compliance,tolerability,willingness to repeat the preparation and the difficulty degree of performing BP.ConclusionsThe 4-SD PEG regimen was superior to a routine morning-only 2-MO PEG preparation for bowel cleansing in Asian population with colorectal surgery,given the higher preparation quality and patient satisfaction.In addition patient tolerability and compliance were comparable between two groups,other than more sleep disturbances in 4-SD group.