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 rates of colorectal cancer (CRC) progressively increase with age, and this rise is particularly prominent after the age of 50 years. Therefore, the population ≥ 50 years in age requires long-term and regular colonoscopies. Uncomfortable bowel preparation is the main reason that prevents patients from undergoing regular colonoscopies. The bowel preparation regimen of 4-L polyethylene glycol (PEG) is effective but poorly tolerated.
Reducing water intake to 2 L can improve comfort, while following a low-residue diet and using lactulose as an adjuvant can enhance the effectiveness of bowel preparation. Therefore, we proposed a bowel preparation regimen involving a mixture of 2 L water with PEG and lactulose along with a low-residue diet for hospitalized patients ≥ 50 years in age who were undergoing colonoscopy.
This study aimed to evaluate the effectiveness, comfort, and safety of a 2-L PEG + 30-mL lactulose + low-residue diet regimen.
Non-inferiority analysis was employed to determine whether the efficacy of the regimen of 2-L PEG + 30-mL lactulose + a low-residue diet was not inferior to that of the 4-L PEG regimen. The analysis was performed using intention-to-treat and per-protocol approaches. The primary outcome was to compare the percentage of adequate bowel preparation in each bowel segment and the whole colon in group 1 with that in group 2 as well as to compare the mean Boston bowel preparation scale scores in each bowel segment and the whole colon between the two groups. The secondary outcome was to compare the difference in the comfort and safety of bowel preparation between group 1 and group 2. The comfort assessment included comfort score, sleep duration on the night before colonoscopy, number of awakenings during sleep on the night before colonoscopy, and the presence of bowel incontinence during bowel preparation. Safety assessment included laboratory test results of serum potassium, sodium, calcium, and creatinine and plasma B-type brain natriuretic peptide before and after bowel preparation.
The bowel preparation regimen comprising a low dose of 2-L PEG + 30-mL lactulose + a low-residue diet had a good bowel preparation effect along with comfort and safety profiles for patients ≥ 50 years in age. Furthermore, in the subgroup of patients ≥ 75 years in age who were at higher risk of inadequate bowel preparation, the 2-L PEG + 30-mL lactulose + a low-residue diet regime was not inferior to the 4-L PEG regimen.
In 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 that yielded by the 4-L PEG regimen and even provided better comfort.
Patients ≥ 50 years in age require long-term and regular colonoscopies due to their notably higher CRC morbidity and mortality. The bowel preparation regimen of 2-L PEG + 30-mL lactulose + a low-residue diet is comparable with the high-dose (4 L) PEG regimen for bowel cleansing and even provides better comfort. These study results may contribute to supporting and improving decision-making in clinical practice.