Significance: Colorectal Cancer screening is an important tool in reducing mortality by detecting both precancerous polyps and cancer at the early stage. Effective bowel cleansing is a prerequisite for optimal investigation of the colon during colonoscopy. Polyethylene Glycol (PEG) 3350 is a safe, effective, non-absorbable, osmotically balanced electrolyte lavage solution that is used the day before the colonoscopy. This study aims to determine the minimum optimal dose of PEG 3350 in terms of patient adherence to the bowel preparation and the acceptability of the bowel preparation by using the Boston Bowel Preparation Scores (BBPS) in Manila Doctors Hospital (MDH)
Methodology: The study is a prospective, randomized, single-blinded, controlled study from July 2016 to November 2016. The study involved adult patients that have undergone elective colonoscopy at MDH and the exclusion criteria included patients with suspicion of colonic obstruction or ileus/subileus, previous colonic surgery, pregnancy, inability to consent, and any patient who has active lower GI bleeding that requires emergency endoscopic procedures. Eligible patients who gave their consent to participate in the study were randomly assigned to 2 different preparations of PEG. Endoscopists were timed in doing the colonoscopy from start up to cecal intubation and the adequacy of bowel preparations were graded using the BBPS. Data were managed using Microsoft Excel software. The results were analyzed using STATA 13.1.
Recommendation: The use of 10 sachets of PEG may be acceptable for bowel preparation for colonoscopy compared to the recommended use of 14 sachets. However, future studies with a larger sample size may be required to further strengthen this observation.
Results: A total of 78 patients were recruited for the study. Both the 10 and 14 sachet groups had 37 out of 39 patients (94.9%, p-value= 1.0) that were able to comply with the bowel preparation. Thirty-eight out of thirty-nine patients (97.4%, p-value = 1.0) from both groups said that it was comfortable to use PEG-3350. Nausea was the most common side effect mentioned for both groups (p-value =0.52). The average time to reach the cecum was 713 seconds (range 113-3840; SD + 695) for the 10 sachet group and 723 seconds (range 125-2416; SD + 531 for the 14 sachet group (p=value 0.947.) The quality of the bowel preparations revealed a mean Boston Bowel Preparation Score (BBPS) of 7.25 (+ 1.2) for the 10 sachet group while a BBPS of 7.21 (+ 1.5) for the 14 sachet group (p value = 0.90.)
Conclusion: PEG 3350 is generally well tolerated, effective, and safe to use as a bowel preparation for colonoscopy.
Keywords: Prospective study, polyethylene glycol 3350, bowel preparation, colonoscopy, Boston Bowel Preparation Scores, BBPS, tolerance, comparison of doses