The impact of low- versus standard-volume bowel preparation on participation in primary screening colonoscopy: a randomized health services study

Abstract

Background The aim of this study was to evaluate the impact of low-volume vs. standard-volume bowel preparation on participation in screening colonoscopy, bowel preparation quality, and lesion detection rates.

Methods This was a multicenter, randomized, health services study within the population-based primary colonoscopy screening program in Poland. Individuals aged 55 – 62 years were randomized in a 1:1 ratio to bowel preparation with a low-volume (0.3 L sodium picosulfate with magnesium citrate) or standard-volume (4 L polyethylene glycol) regimen and then invited to participate in screening colonoscopy. The primary outcome measure was the rate of participation in screening colonoscopy. Compliance with the assigned bowel preparation, bowel preparation quality, and lesion detection rates were also evaluated.

Results A total of 13 621 individuals were randomized and 13 497 were analyzed (6752 in the low-volume group and 6745 in the standard-volume group). The participation rate (16.6 % vs. 15.5 %; P = 0.08) and compliance rate (93.3 % vs. 94.1 %; P = 0.39) did not differ significantly between the groups. In the low-volume group, fewer participants had adequate bowel preparation compared with the standard-volume group (whole colon 79.0 % vs. 86.4 %, P < 0.001; proximal colon 80.1 % vs. 87.3 %, P < 0.001). Detection rates of advanced adenoma (AADR) and advanced serrated polyps (ASPDR) were lower in the low-volume group than in the standard-volume group (AADR in the proximal colon 2.6 % vs. 4.3 %, P = 0.02; ASPDR in the whole colon 2.0 % vs. 3.3 %, P = 0.04; ASPDR in the proximal colon 1.0 % vs. 1.9 %, P = 0.048).

Conclusion When compared with a standard-volume bowel preparation with polyethylene glycol, low-volume bowel preparation with sodium picosulfate/magnesium citrate did not improve participation rate or lesion detection rates, and negatively affected bowel preparation quality.

• References

• 1 Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J. et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013; 49: 1374-1403
• 2 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015; 65: 5-29
• 3 Zauber AG, Sidney J, Winawer MD. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
• 4 von Karsa L, Patnick J, Segnan N. et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy 2013; 45: 51-59
• 5 Richardson L, Rim S, Plescia M. Vital signs: colorectal cancer screening among adults aged 50-75 years – United States, 2008. MMWR Morb Mortal Wkly Rep 2010; 59: 808-812
• 6 Thiis-Evensen E, Kalager M, Bretthauer M. et al. Long-term effectiveness of endoscopic screening on incidence and mortality of colorectal cancer: a randomized trial. United European Gastroenterol J 2013; 1: 162-168
• 7 Bretthauer M, Kaminski MF, Loberg M. et al. Population-based colonoscopy screening for colorectal cancer: a randomized clinical trial. JAMA Intern Med 2016; 176: 894-902
• 8 Segnan N, Senore C, Andreoni B. et al. Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology 2007; 132: 2304-2312
• 9 Lisi D, Hassan C, Crespi M. Participation in colorectal cancer screening with FOBT and colonoscopy: an Italian, multicentre, randomized population study. Dig Liver Dis 2010; 42: 371-376
• 10 Stoop EM, de Haan MC, de Wijkerslooth TR. et al. Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. Lancet Oncol 2012; 13: 55-64
• 11 Inadomi JM, Vijan S, Janz NK. et al. Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med 2012; 172: 575-582
• 12 Quintero E, Castells A, Bujanda L. et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med 2012; 366: 697-706
• 13 McLachlan S-A, Clements A, Austoker J. Patients’ experiences and reported barriers to colonoscopy in the screening context – a systematic review of the literature. Patient Educ Couns 2012; 86: 137-146
• 14 de Wijkerslooth TR, de Haan MC, Stoop EM. et al. Reasons for participation and nonparticipation in colorectal cancer screening: a randomized trial of colonoscopy and CT colonography. Am J Gastroenterol 2012; 107: 1777-1783
• 15 Jones RM, Devers KJ, Kuzel AJ. et al. Patient-reported barriers to colorectal cancer screening: a mixed-methods analysis. Am J Prev Med 2010; 38: 508-516
• 16 Tan JJ, Tjandra JJ. Which is the optimal bowel preparation for colonoscopy – a meta-analysis. Colorectal Dis 2006; 8: 247-258
• 17 Worthington J, Thyssen M, Chapman G. et al. A randomised controlled trial of a new 2 litre polyethylene glycol solution versus sodium picosulphate + magnesium citrate solution for bowel cleansing prior to colonoscopy. Curr Med Res Opin 2008; 24: 481-488
• 18 Park SS, Sinn DH, Kim YH. et al. Efficacy and tolerability of split-dose magnesium citrate: low-volume (2 liters) polyethylene glycol vs. single- or split-dose polyethylene glycol bowel preparation for morning colonoscopy. Am J Gastroenterol 2010; 105: 1319-1326
• 19 Hakama M, Malila N, Dillner J. Randomised health services studies. Int J Cancer 2012; 131: 2898-2902
• 20 Kaminski MF, Kraszewska E, Rupinski M. et al. Design of the Polish Colonoscopy Screening Program: a randomized health services study. Endoscopy 2015; 47: 1144-1150
• 21 Hassan C, Bretthauer M, Kaminski MF. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45: 142-150
• 22 Bugajski M, Wieszczy P, Hoff G. et al. Modifiable factors associated with patient-reported pain during and after screening colonoscopy. Gut 2017;
• 23 Regula J, Zagorowicz E, Butruk E. Implementation of a national colorectal cancer screening program. Curr Colorectal Cancer Rep 2006; 2: 25-29
• 24 Lai EJ, Calderwood AH, Doros G. et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69: 620-625
• 25 Bosman FT, Carneiro F, Hruban RH. et al. WHO classification of tumours of the digestive system. Lyon: IARC; 2010
• 26 Jin Z, Lu Y, Zhou Y. et al. Systematic review and meta-analysis: sodium picosulfate/magnesium citrate vs. polyethylene glycol for colonoscopy preparation. Eur J Clin Pharmacol 2016; 72: 523-532
• 27 Lieshout Iv, Munsterman ID, Eskes AM. et al. Systematic review and meta-analysis: sodium picosulphate with magnesium citrate as bowel preparation for colonoscopy. United European Gastroenterol J 2016; 5: 917-943
• 28 Kojecky V, Matous J, Keil R. et al. A head-to-head comparison of 4-L polyethylene glycol and low-volume solutions before colonoscopy: which is the best? A multicentre, randomized trial. Int J Colorectal Dis 2017; 32: 1763-1766
• 29 Leitao K, Grimstad T, Bretthauer M. et al. Polyethylene glycol vs sodium picosulfate/magnesium citrate for colonoscopy preparation. Endosc Int Open 2014; 2: E230-E234
• 30 Manes G, Amato A, Arena M. et al. Efficacy and acceptability of sodium picosulphate/magnesium citrate vs low-volume polyethylene glycol plus ascorbic acid for colon cleansing: a randomized controlled trial. Colorectal Dis 2013; 15: 1145-1153