AUTHOR=Gimeno-García Antonio Z. , Hernández Goretti , Baute Dorta José Luis , Reygosa Cristina , de la Barreda Raquel , Hernandez-Bustabad Alberto , Amaral Carla , Cedrés Yaiza , del Castillo Rocío , Nicolás-Pérez David , Jiménez Alejandro , Alarcon-Fernández Onofre , Hernandez-Guerra Manuel , Romero Rafael , Alonso Inmaculada , González Yanira , Adrian Zaida , Hernandez Domingo , Ramos Laura , Carrillo Marta , Felipe Vanessa , Hernández Anjara , Rodríguez-Jiménez Consuelo , Quintero Enrique 

TITLE=An Enhanced High-Volume Preparation for Colonoscopy Is Not Better Than a Conventional Low-Volume One in Patients at Risk of Poor Bowel Cleansing: A Randomized Controlled Trial

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.654847

DOI=10.3389/fmed.2021.654847

ISSN=2296-858X

ABSTRACT=<p><bold>Objective:</bold> We tested the hypothesis that an enhanced bowel preparation strategy (EBS) improves colonic cleansing in patients at high risk for inadequate bowel cleansing (HRI).</p><p><bold>Methods:</bold> This prospective randomized clinical trial included consecutive HRI patients referred for outpatient colonoscopy between February and October 2019. HRI was considered if patients scored &gt;1.225 according to a previously validated bowel-cleansing predictive score. HRI patients were randomized (1:1) to a low-volume conventional bowel cleansing strategy (CBS) (1-day low residue diet (LRD) plus 2 L of polyethylene glycol (PEG) plus ascorbic acid) or to an EBS (3-day LRD plus 10 mg oral bisacodyl plus 4 L PEG). The Boston Bowel Preparation Scale (BBPS) was used to assess the quality of cleanliness. Intention-to-treat (ITT) and per protocol (PP) analyses were performed. A sample size of 130 patients per group was estimated to reach a 15% difference in favor of EBP.</p><p><bold>Results:</bold> A total of 253 HRI patients were included (mean age 69.8 ± 9.5 years, 51.8% women). No statistically significant differences were found in the BBPS scale between the two groups in the ITT analysis (CBS 76.8% vs. EBS 79.7%, <italic>P</italic> = 0.58) or PP analysis (CBS 78% vs. EBS 84.3%, <italic>P</italic> = 0.21), risk difference 2.9% (95% CI−7.26 to 39.16) in the ITT analysis, or risk difference 6.3% (95% CI−3.48 to 16.08) in PP analysis. No differences in preparation tolerance, compliance, adverse effects, or colonoscopy findings were found.</p><p><bold>Conclusion:</bold> EBS is not superior to CBS in hard-to-prepare patients. (EUDRACT: 2017-000787-15, NCT03830489).</p><p><bold>Clinical Trial Registration:</bold><ext-link ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">www.ClinicalTrials.gov</ext-link>, identifier NCT03830489.</p>