Colon to Rectum
United European Gastroenterol J. 2023;11(5):448–57
Efficacy of different bowel preparation regimen volumes for colorectal cancer screening and compliance with European Society of Gastrointestinal Endoscopy performance measures
Background: Various volumes of bowel preparation are used in clinical practice. There is conflicting data on the effectiveness of individual regimens. This study aims to evaluate the efficacy and compliance of currently used bowel preparations with the European Society of Gastrointestinal Endoscopy (ESGE) performance measures using data of the Dutch nationwide colorectal cancer (CRC) screening program.
Methods: In a prospective, multicenter endoscopy database, the authors identified all CRC screening colonoscopies performed in 15 Dutch endoscopy centers from 2016 to 2020. They excluded procedures without documented bowel preparation or the Boston Bowel Preparation Scale (BBPS) score. Bowel preparation regimens were categorized into 3 groups, that is, 4-l (polyethylene glycol [PEG]), 2-l (2-l PEG with ascorbic acid) and ≤ 1-l volumes (sodium picosulfate with magnesium citrate, 1-l-PEG with sodium sulfate and ascorbic acid or oral sulfate solution). ESGE performance measures included adequate BBPS score (≥ 6) (> 90%), cecal intubation rate (CIR, > 90%), adenoma detection rate (ADR, > 25%) and polyp detection rate (PDR, > 40%). Logistic regression was performed to identify predictive factors for adequate BBPS and patient discomfort.
Results: A total of 39,042 CRC screening colonoscopies were included. BBPS scores, CIR, ADR and PDR for 4-l, 2-l and ≤ 1-l regimens all met the minimum ESGE performance measures standards. However, an adequate BBPS score was more frequently seen with 2-l regimens (98.0%) as compared to 4-l (97.1%) and ≤ 1-l regimens (97.0%) (p < 0.001), respectively. In addition, CIR was higher for ≤ 1-l (98.4%) versus 4-l (97.7%) and 2-l regimens (97.9%) (p = 0.001), ADR higher for lower volume (≤ 1-l [60.0%] and 2-l [61.2]) versus higher volume (4-l [58.6%]) regimens (p < 0.001), and PDR higher for ≤ 1-l (70.0%) and 2-l (70.8%) versus 4-l (67.2%) regimens (p < 0.001). BBPS for ≤ 1-l regimens was higher when combined with bisacodyl (97.3%) than without (95.6%) (p < 0.001). Overall, bisacodyl use was independently associated with higher patient discomfort (odds ratio = 1.47, 95% confidence interval: 1.26–1.72).
Conclusions: Despite variations in bowel preparation volumes, all regimens meet the minimum European Society of Gastrointestinal Endoscopy performance measures for bowel preparation and other quality parameters. Boston Bowel Preparation Scale can be further improved if ultralow volume regimens are combined with bisacodyl. The choice for either bowel preparation volume can therefore be based on volume-tolerance and patient preference.
DOI: 10.1002/ueg2.12386