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Same-Day Bowel Preparation: Excelling Bowel Cleansing Efficacy in Selected Outpatients.

1409 DISEASES OF THE COLON & RECTUM VOLUME 62: 12 (2019) Bowel preparation has a pivotal role in colonoscopy. Bowel cleansing is related to diagnostic accuracy, and inadequate bowel preparation leads to missed lesions, diagnostic delays, nuisances, and increased costs. On the other hand, bowel preparation is the worst perceived part of the colonoscopy process, and the patient’s experience is important to improve the adherence with follow-up colonoscopies. In the study by Seo et al, the authors compared the bowel cleansing efficacy, adverse events (AEs), and tolerability of 2 dosages of 4-L polyethylene glycol (PEG), a same-day dose (SDD) and a 2-day overnight split dose (SPD), for colonoscopies performed in outpatients in the midmorning (10:00 AM to 12:00 PM ) or in the afternoon (1:30 PM to 5:00 PM). The SDD consisted of ingesting 4 L of PEG starting at 5:00 AM in 2 to 3 hours for morning colonoscopy or taking 2 L of PEG starting at 7:00 AM, followed by a 2-hour pause and taking the remaining 2 L of PEG starting at 10:00 AM for an afternoon colonoscopy. The SPD consisted of ingesting 2 L of PEG at 9:00 PM the day before colonoscopy and the remaining 2 L of PEG at 7:00 AM for morning colonoscopy or at 10:00 AM for afternoon colonoscopy. This study showed a great bowel preparation success with no differences between groups: 98.8% for SDD and 98.2% for SPD. On the other side, the tolerability and acceptability of both bowel preparation protocols were equally poor. Approximately 40% of the participants experienced an AE, without differences between groups. Nausea and vomiting were numerically more frequent in the SDD group (24% and 13%) than in the SPD group (20% and 8%), although it was not statistically significant. On the other hand, sleep disturbances were more common in the SPD group. The overall satisfaction was low, as ≈50% of the participants were dissatisfied or very dissatisfied, and the willingness to reuse the same bowel preparation protocol was also low (53%), with no differences between groups. This randomized controlled trial has several strengths. It has been well conducted by experienced endoscopists. Second, bowel preparation success was measured with the Boston Bowel Preparation Scale. This scale has been well validated, and it is extensively used through the world, allowing the comparison between studies. Third, several quality recommendations for assuring a good rate of bowel preparation success were implemented in both study groups, such as adequate diet recommendations and an intensive medical education through a telephone call reminder of the bowel instructions 2 days before the colonoscopy. As a result, the variables related with good bowel preparation were almost perfect, such as an excellent adherence to the bowel preparation protocol and a short interval between the last ingestion of the laxative and the colonoscopy, which was <6 hours in 92% of the participants. Nevertheless, to understand the outstanding good rate of adequate bowel preparation (98%), the extremely good compliance with the bowel preparation protocol has to be taken into account, especially regarding the high rate of full laxative ingestion of the 4-L PEG, which was ≈92%, considering that >20% of the participants experienced nausea and ≈10% did vomit. In addition, participants with severe comorbidities (ASA >II) or elder patients (>75 y) were excluded, and all of the participants were of East Asian ethnicity, with a low BMI. This selected Funding/Support: None reported.