Comparison of PEG-Based and Non-PEG Bowel Preparation for Emergency Colonoscopy in Acute Lower Gastrointestinal Bleeding: A Real-World Cohort Study with IPTW Analysis.

PURPOSE: The optimal bowel preparation for acute lower gastrointestinal bleeding (ALGIB) in the emergency remains uncertain. This study aimed to compare the efficacy and safety of oral versus non-oral laxative approaches for emergency colonoscopy in ALGIB patients.

METHODS

We retrospectively analyzed 157 patients undergoing emergency colonoscopy for ALGIB, stratified into PEG (n = 67) and non-PEG (n = 90) groups. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline confounders, including pre-procedural suspected etiology. Primary outcomes were endoscopic diagnosis (including definitive and presumptive) and hemostasis rates. Secondary outcomes included bowel preparation quality, procedural completion, and medical resource utilization. Post hoc analyses were performed by categorizing etiologies into focal/subtle and diffuse/obvious types.

RESULTS

After IPTW adjustment, overall core outcomes including endoscopic diagnosis (86.5% vs. 80.3%), stigmata of recent hemorrhage (SRH) detection (42.7% vs. 43.9%) and hemostasis (12.5% vs. 16.9%) were comparable between groups (all adjusted P > 0.05). The PEG group demonstrated significantly higher rates of adequate bowel preparation (BBPS ≥ 6: 70.6% vs. 31.8%, P < 0.001) and cecal intubation (86.2% vs. 55.9%, P = 0.001), with no significant differences between groups in procedural efficiency or resource utilization (all P > 0.05). However, outcomes were significantly etiology-dependent. Diffuse/obvious lesions were associated with significantly higher definite diagnosis rates (64.3% vs. 38.6%, P = 0.004) but lower cecal intubation success (66.1% vs. 84.3%, P = 0.017) compared to focal/subtle lesions.

CONCLUSION

Clinical outcomes in ALGIB are fundamentally etiology-dependent. While PEG and non-PEG strategies achieve comparable overall diagnostic and therapeutic yields, their distinct clinical utilities vary across lesion types. These findings advocate for a stratified, etiology-driven approach to bowel preparation. Future efforts should prioritize the development of pre-procedural predictive models to refine individualized management strategies.