| Background: Compound Polyethylene Glycol Electrolyte Powder(PEG)is the most widely used cleaner for bowel preparation in clinical practice.There is no uniform standard for application protocols of PEG in bowel preparation.Thus,exploring the best bowel preparation protocol of PEG is crucial to achieve high-quality colonoscopic diagnosis and treatment.Objective: To provide theoretical basis for selection of PEG’s best bowel preparation protocol and thereby achieve clinical high-quality colonoscopy,the effects of different application protocols of PEG for bowel preparation and different time of colonoscopy on bowel cleansing efficacy and endoscopic polyp detection rate are investigated,and the influencing factors of bowel cleansing are analyzed.Methods: A retrospective analysis of 573 hospitalized patients who underwent colonoscopy and met the inclusion criteria in the Second affiliated Hospital of Dalian Medical University from October 2019 to September 2020 was performed.According to the bowel cleansing protocol,the patients were divided into group A(with single oral 2L PEG solution)and group B(with multiple oral 3L PEG solution).According to the time of colonoscopy,they were divided into morning group(colonoscopy from 8:00 to 12:00)and afternoon group(colonoscopy from 13:00 to 17:00).According to the efficacy of bowel cleansing,they were divided into sufficient bowel cleansing group(Boston score:total score ≥ 6 points,each segment of colon ≥ 2 points)and insufficient bowel cleansing group(Boston score:total score < 6 or any segment of colon score < 2 points).To explore the best bowel preparation protocol of PEG,the efficacy of bowel cleansing and the detection rate of endoscopic polyp among the groups were compared.For further analysis of the factors that may affect the efficacy of bowel cleansing,single-factor analysis and multi-factor analysis were performed to investigate the risk factors that affect the efficacy of bowel cleansing.Results: 1.General information: a total of 573 patients were included in this study,including 265 patients in group A(46%)and 310 patients in group B(54%).There were112 males(46%)and 143 females(54%)in group A,with a median age of 55 years and a median BMI of 24.34.In group B,there were 135 males(44%)and 173 females(56%),with a median age of 60 years and a median BMI of 24.32.There were 459patients(80%)in the morning group and 114 patients(20%)in the afternoon group.And there were 199 males(43%)in the morning group and 260 females(57%),with a median age of 59.5 years and a median BMI of 24.34.In the afternoon group,there were 58 males(51%)and 56 famales(49%),with a median age of 57 years and a median BMI of 24.32.There were 415 patients(72%)in sufficient bowel cleansing group and 158 patients(28%)in insufficient bowel cleansing group.And there were 176males(42%)and 239 females(58%)in sufficient bowel cleaning group,with a median age of 55 years and a median BMI of 24.34.There were 81 males(51%)and 77 females(49%)with a median age of 59.5 years and a median BMI of 24.36 in insufficient bowel cleansing group.The differences in gender,age and BMI were not statistically significant between different groups(P>0.05).2.Comparison of bowel cleansing efficacy between different groups:(1)Group A and Group B: in BBPS: total score,right colon score,transverse colon score,left colon score,right colon bubble score,transverse colon bubble score,left colon bubble score,and the efficacy of bowel cleansing.All the differences were statistically significant among different groups(P<0.05),and there were higher scores and more sufficient bowel cleansing in Group B.But there was no statistically significant difference in the total bubble score between the two groups(P>0.05).(2)Morning group and afternoon groups: in BBPS: total score,right colon score,transverse colon score,left colon score,the efficacy of bowel cleansing.All the differences were statistically significant and P values were all less than 0.05.Moreover,the scores in the morning group were higher and the bowel cleansing was more sufficient.There were no significant differences in the total bubble score,right colon bubble score,transverse colon bubble score,and left colon bubble score between the two groups(P> 0.05).3.Comparison of cecal insertion rate among different groups:(1)Group A and Group B: Difference in cecal insertion rate between the two groups was not statistically significant(P>0.05).(2)Morning group and afternoon group: the difference in cecal insertion rate was not statistically significant(P>0.05).4.Comparison of the endoscopic polyp detection rate among different groups:(1)Group A and Group B: the total polyps detection rate,the detection rate of polyps less than 5mm in diameter,the detection rate of adenomatous polyps,all the differences of which were statistically significant(P<0.05),and the polyp detection rate in Group B was higher.The differences of the detection rate of polyps 5-10 mm in diameter and more than 10 mm in diameter were not statistically significant(P>0.05).(2)Morning group and afternoon group: the total polyps detection rate,the detection rate of polyps less than 5mm in diameter,the detection rate of polyps 5-10 mm in diameter,the detection rate of polyps more than 10 mm in diameter,and the detection rate of adenomatous polyps,all of which showed that the difference was not statistically significant between the two groups(P>0.05).5.Analysis of the factors that may affect the efficacy of bowel cleansing:abdominal pain,diarrhea,constipation,colonoscopy history,the time of colonoscopy,bowel preparation protocol and the efficacy of bowel cleansing were potentially related factors(P<0.05);gender,age,BMI,smoking history,drinking history,hypertension,diabetes,stroke and history of abdominal surgery were not significantly related to the efficacy of bowel cleansing(P>0.05).6.Analysis of related risk factors affecting the efficacy of bowel cleansing:constipation(OR value=2.265,P=0.001),the time of colonoscopy(OR value=2.506,P=0.000),bowel preparation protocol(OR value=3.061,P=0.001)were the risk factors related to the efficacy of bowel cleansing(P<0.05);abdominal pain(P=0.199),diarrhea(P=0.331),and colonoscopy history(P=0.134)were not related risk factors for the efficacy of bowel cleansing(P>0.05).7.Analysis of independent risk factors affecting the efficacy of bowel cleansing:constipation(OR value=2.273,P=0.001),the time of colonoscopy(OR value=2.498,P=0.000),bowel preparation protocol(OR value=3.710,P=0.000)were independent risk factors for the efficacy of bowel cleansing(P <0.05).Conclusions:1.The bowel cleansing efficacy of the multiple oral 3L PEG solution protocol is better than that of the single oral 2L PEG solution protocol,which can increase the detection rate of the total polyps,the polyps less than 5mm in diameter,and the adenomatous polyps in colonoscopy,but there are no differences between the detection rate of polyps 5-10 mm and more than 10 mm in diameter.2.The bowel cleansing efficacy of colonoscopy in morning group is better than that in the afternoon group,but there is no difference respectively in the detection rate of the total polyps,the polyps less than 5mm,5-10 mm,more than 10 mm in diameter and adenomatous polyps between the two groups.3.Abdominal pain,diarrhea,constipation,history of colonoscopy,the time of colonoscopy and bowel preparation protocol may affect bowel cleansing efficacy,which should be paid attention to by clinicians during bowel preparation.4.Constipation,the time of colonoscopy and bowel preparation protocol are independently related to bowel cleansing efficacy.No history of constipation,colonoscopy in the morning and multiple oral 3L PEG solution protocol are more benefitial to sufficient bowel cleansing.In clinical applications,the best bowel preparation protocol with PEG is to improve constipation actively,use multiple oral 3L PEG solution protocol,and perform a colonoscopy in the morning. |
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