Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2021; 13(12): 659-672
Published online Dec 16, 2021. doi: 10.4253/wjge.v13.i12.659
Efficacy and tolerability of high and low-volume bowel preparation compared: A real-life single-blinded large-population study
Vincenzo Occhipinti, Paola Soriani, Francesco Bagolini, Valentina Milani, Emanuele Rondonotti, Maria Laura Annunziata, Flaminia Cavallaro, Sara Vavassori, Maurizio Vecchi, Luca Pastorelli, Gian Eugenio Tontini
Vincenzo Occhipinti, Digestive Endoscopy and Gastroenterology Unit, A. Manzoni Hospital, ASST Lecco, Lecco 23900, Italy
Vincenzo Occhipinti, Paola Soriani, Francesco Bagolini, Maria Laura Annunziata, Flaminia Cavallaro, Sara Vavassori, Maurizio Vecchi, Luca Pastorelli, Gian Eugenio Tontini, Gastro-enterology Unit, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
Paola Soriani, Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, Carpi Hospital, Carpi 41012, Italy
Valentina Milani, Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese 20097, Italy
Emanuele Rondonotti, Gastroenterology Unit, Ospedale Valduce, Como 22100, Italy
Flaminia Cavallaro, Maurizio Vecchi, Gian Eugenio Tontini, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
Sara Vavassori, Luca Pastorelli, Gastroenterology and Hepatology Unit, ASST Santi Paolo e Carlo, Milan 20142, Italy
Maurizio Vecchi, Gian Eugenio Tontini, Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Italy
Luca Pastorelli, Department of Biomedical Sciences for Health, University of Milan, Milan 20122, Italy
Author contributions: Occhipinti V contributed to the acquisition, analysis, and interpretation of data, drafting and critical revision of the manuscript; Soriani P, Bagolini F, Annunziata ML, Cavallaro F, Vavassori S, Vecchi M contributed to the acquisition of data and critical revision of the manuscript; Milani V analyzed the data; Rondonotti E contributed to the analysis and interpretation of data, critical revision of the manuscript; Pastorelli L contributed to the acquisition, analysis and interpretation of data, critical revision of the manuscript; Tontini GE contributed to the study concept and design, acquisition, analysis and interpretation of data, critical revision of the manuscript and study supervision.
Institutional review board statement: The study was approved by the local Ethics Committee of San Raffaele Hospital (Approval No. 90/INT/2014).
Informed consent statement: A specific written informed consent was taken from all the study participants.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: Dataset of this study is available from the corresponding author at luca.pastorelli@unimi.it, upon reasonable request. Informed consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luca Pastorelli, MD, PhD, Associate Professor, Gastroenterology Unit, IRCCS Policlinico San Donato, Piazza Malan, San Donato Milanese 20097, Italy. luca.pastorelli@unimi.it
Received: April 24, 2021
Peer-review started: April 24, 2021
First decision: June 13, 2021
Revised: June 25, 2021
Accepted: December 2, 2021
Article in press: December 2, 2021
Published online: December 16, 2021
Processing time: 233 Days and 16.3 Hours
ARTICLE HIGHLIGHTS
Research background

Colonoscopy is a key procedure for the diagnosis of several colorectal pathologies and for prevention of colorectal cancer. The diagnostic yield of colonoscopy is strongly influenced by quality of bowel preparation. In the last years, several low-volume (LV) preparations have been introduced with the aim to improve patients’ adherence and compliance.

Research motivation

LV preparations have demonstrated similar cleansing effects compared to standard, high-volume (HV) preparation in randomized controlled trials. However, few real-life studies have compared these two types of preparation in terms of clinically relevant outcomes such as lesions detection.

Research objectives

Primary aim of our study was to compare the real-life efficacy of a standard HV preparation (4 L polyethylene glycol) and of a LV preparation (2 L polyethylene glycol with bisacodyl), either in terms of adequate bowel preparation rate (defined as Boston Bowel Preparation Scale score ≥ 2 in all bowel segments) or in terms of lesions detection. Secondary aim was to compare patients’ self-reported adherence and tolerability.

Research methods

A prospective study was conducted from 1 December 2014 to 31 December 2016, enrolling all the consecutive outpatients referred for colonoscopy in a single endoscopy center in Italy. Patients were free to choose one of the two proposed preparations (HV or LV). A questionnaire was administered to the patients to collect comorbidities, type of preparation chosen, adherence to preparation and tolerability. Indications for colonoscopy, type of scope used (high-definition, HD, or standard-definition, SD), Boston Bowel Preparation Scale (BBPS) score for each colonic segment, histology of all the lesions resected or biopsied were collected.

Research results

LV was chosen by 52% of patients (50.8% of men, 54.9% of women). HD scopes were used in 33.4% of patients, without difference in the two groups (P = 0.605). There was no difference between HV and LV preparations in terms of adequate bowel preparation, even if mean global BBPS score was higher for HV preparation when compared to LV. Compared to LV, HV preparation resulted higher in polyp detection rate (PDR) but not in advanced adenoma detection rate (AADR) and cancer detection rate. Considering the type of colonoscope used, we observed lower PDR, adenoma detection rate (ADR) and AADR with LV preparation with SD colonoscopes, without differences between the two preparations with HD instruments.

Research conclusions

Despite similar adequate bowel preparation rate among the two preparations compared, we observed higher PDR, ADR and AADR with HV preparation compared to LV. The difference is mainly observed when SD endoscopes are used. The two preparations were stated as equally tolerated by the patients, but self-reported adherence was higher with LV.

Research perspectives

In the last years we have observed an increasing trend towards the use of LV preparations to increase patients’ satisfaction. However, primary aim of bowel preparation is to minimize the risk of missing colorectal lesions. Further studies, either randomized controlled trials or real-life studies, are warranted to compare efficacy in lesions detection of new LV products to standard HV preparation.