Ayman Usmani, MD1, Michael Sighinolfi, MD2, Matthew Schlossberger, MD2, Salini Samyuktha Gadupudi, MSc(Epi)3, Ann Marie Joyce, MD2, Laurie B. Grossberg, MD2; 1Lahey Hospital and Medical Center, Revere, MA; 2Lahey Hospital and Medical Center, Burlington, MA; 3Lahey Hospital and Medical Center, Malden, MA
Introduction: Colonoscopy is the gold standard for screening and surveillance of colon cancer, and data support split-dose bowel preparation as the standard of care. The primary aim of this study is to determine the adequacy of split-dose 2-L polyethylene glycol-3350 (PEG-3350) with bisacodyl versus split-dose 4-L PEG electrolyte solution (PEG-ELS). The secondary aims are to assess patient tolerance of the bowel preparations and to determine predictors of inadequate bowel preparation. Methods: A questionnaire was distributed to consecutive patients presenting for outpatient colonoscopy from 7/1/2019-8/31/2019 at a tertiary care teaching hospital. Patient demographics, comorbidities, and the type, amount, and tolerability of bowel preparation were collected prior to the procedure. Rates of adequate Boston Bowel Preparation Score (BBPS), defined as overall BBPS ≥ 6 and ≥ 2 in all three segments, and tolerability between the PEG-3350 with bisacodyl and PEG-ELS preparations were compared using the Chi-square test. Multiple logistic regression was performed to determine predictors of inadequate bowel preparation. Results: 1206 patients of 22 endoscopists were offered the questionnaire. 820 completed the survey and 463 subjects [PEG-ELS (n=211) vs. PEG-3350 (n=252)] met inclusion criteria (Table 1). There was no significant difference in adequate BBPS between PEG-3350 and PEG-ELS (96.0% vs. 93.8%, P=0.28); however, patients taking PEG-ELS were more likely to achieve BBPS of 9 in comparison to PEG-3350 (60.7 % vs 47.6% P=0.005). More patients completed PEG-3350 (92.1% vs 79.6%, P=0.005), rated PEG-3350 easy or acceptable to tolerate (75.7% vs 62.6%, P=0.007), and were less likely report a bad taste (P=0.001) compared with patients taking PEG-ELS. There were no differences between the preparations in reported adverse effects (Table 2). Constipation (OR 3.8, P=0.01), the use of an assistive device (OR 13.0, P< 0.05), incomplete bowel preparation (OR 3.1, P=0.01), and poor tolerability of the bowel preparation (OR 2.3, P=0.05) were identified as significant predictors of BBPS < 6 in univariate logistic regression. However, only constipation (OR 3.7, p=0.03) and the use of assisted devices (OR 9.2, p=0.007) were identified as predictors of BBPS < 6 in multivariate regression after adjusting for potential confounders (Table 3). Discussion: Split-dose PEG-3350 with bisacodyl and PEG-ELS are both effective in achieving adequate bowel cleanliness, however, PEG-3350 is better tolerated in comparison to PEG-ELS.
Patient Tolerability of Bowel Preparation
Predictors of Poor Bowel Preparation
Disclosures: Ayman Usmani indicated no relevant financial relationships. Michael Sighinolfi indicated no relevant financial relationships. Matthew Schlossberger indicated no relevant financial relationships. Salini Samyuktha Gadupudi indicated no relevant financial relationships. Ann Marie Joyce indicated no relevant financial relationships. Laurie Grossberg indicated no relevant financial relationships.