Published online Jan 16, 2024. doi: 10.4253/wjge.v16.i1.18
Peer-review started: August 26, 2023
First decision: November 20, 2023
Revised: December 2, 2023
Accepted: December 14, 2023
Article in press: December 14, 2023
Published online: January 16, 2024
Processing time: 141 Days and 17.3 Hours
The incidence and mortality rate of colorectal cancer progressively increase with age and become particularly prominent after the age of 50 years. Therefore, the population that is ≥ 50 years in age requires long-term and regular colonoscopies. Uncomfortable bowel preparation is the main reason preventing patients from undergoing regular colonoscopies. The standard bowel preparation regimen of 4-L polyethylene glycol (PEG) is effective but poorly tolerated.
To investigate an effective and comfortable bowel preparation regimen for hospitalized patients ≥ 50 years in age.
Patients were randomly assigned to group 1 (2-L PEG + 30-mL lactulose + a low-residue diet) or group 2 (4-L PEG). Adequate bowel preparation was defined as a Boston bowel preparation scale (BBPS) score of ≥ 6, with a score of ≥ 2 for each segment. Non-inferiority was prespecified with a margin of 10%. Additionally, the degree of comfort was assessed based on the comfort questionnaire.
The proportion of patients with a BBPS score of ≥ 6 in group 1 was not significantly different from that in group 2, as demonstrated by intention-to-treat (91.2% vs 91.0%, P = 0.953) and per-protocol (91.8% vs 91.0%, P = 0.802) analyses. Furthermore, in patients ≥ 75 years in age, the proportion of BBPS scores of ≥ 6 in group 1 was not significantly different from that in group 2 (90.9% vs 97.0%, P = 0.716). Group 1 had higher comfort scores (8.85 ± 1.162 vs 7.59 ± 1.735, P < 0.001), longer sleep duration (6.86 ± 1.204 h vs 5.80 ± 1.730 h, P < 0.001), and fewer awakenings (1.42 ± 1.183 vs 2.04 ± 1.835, P = 0.026) than group 2.
For hospitalized patients ≥ 50 years in age, the bowel preparation regimen comprising 2-L PEG + 30-mL lactulose + a low-residue diet produced a cleanse that was as effective as the 4-L PEG regimen and even provided better comfort.
Core Tip: Individuals ≥ 50 years in age require long-term and regular colonoscopies. Uncomfortable bowel preparation is the main reason preventing patients from undergoing regular colonoscopies. The 4-L polyethylene glycol (PEG) regimen is effective but poorly tolerated. We observed that the 2-L PEG + 30-mL lactulose + low-residue diet regimen was not inferior to the 4-L PEG regimen. The 2-L PEG + 30-mL lactulose + low-residue diet regimen was more comfortable than the 4-L PEG regimen. In patients ≥ 75 years in age, 2-L PEG + 30-mL lactulose + low-residue diet regimen was still effective.