One-liter polyethylene glycol with ascorbic acid provides comparable cleansing quality to two-liter regimen in bowel preparation for patients with inactive ulcerative colitis ‒ A randomized, multicenter, single-blind trial.

INTRODUCTION

patient-centered care for ulcerative colitis (UC) involves reducing the burden associated with colonoscopy, particularly bowel preparation. Although low-volume preparations have become common in the general population, data on the use of 1-l polyethylene glycol with ascorbic acid (PEG+Asc) in patients with UC are limited. We compared the efficacy, safety, and acceptability of 1-l and 2-l PEG+Asc in patients with quiescent UC.

METHODS

this was a multicenter, randomized, single-blind, non-inferiority study. Adult outpatients with UC who had stable disease activity were randomly allocated to 1-l or 2-l of PEG+Asc for colonoscopy. The degree of bowel cleansing was assessed using the Boston Bowel Preparation Scale and rated as successful cleansing if the score was ≥ 6 with all segment scores ≥ 2. Patient acceptance (ease of administration and willingness to repeat) and tolerability (newly developed symptoms, such as nausea, bloating, and abdominal pain) were assessed using a four-point ordinal scale. Disease activity (partial or full Mayo score) and laboratory data before and after colonoscopy were assessed for safety concerns.

RESULTS

of the 196 randomized patients, 74 in the 1-l group and 70 in the 2-l group, respectively, completed the study. Successful cleansing was achieved in 98.6 % and 97.1 % of patients, respectively (absolute difference -1.4 %, one-sided 97.5 % confidence interval -5.9 %), meeting the non-inferiority margin in the per-protocol analysis. A conservative intention-to-treat analysis did not meet the non-inferiority threshold. Overall tolerability and acceptability were similar, although nausea was reported more frequently in the 1-l group. No significant changes in disease activity were observed, and minor electrolyte shifts occurred more often in the 1-l group but were clinically insignificant.

CONCLUSIONS

one-liter PEG+Asc is effective and safe for bowel preparation in patients with quiescent UC and offers a viable low-volume alternative to the 2-l regimen. Careful patient selection and monitoring may be advisable in elderly or comorbid patients.