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CC BY 4.0 · Endosc Int Open 2025; 13: a25259938
DOI: 10.1055/a-2525-9938
Original article

Real-world effectiveness and safety of 1L polyethylene glycol and ascorbic acid for bowel preparation in patients aged 80 years or older

Salvador Machlab 
1   Gastroenterology, Parc Taulı́ Hospital Universitari, Institut d’Investigació i Innovació Parc Taulı́ I3PT, Sabadell, Spain
,
Vicente Lorenzo-Zúñiga 
2   Gastroenterology, Hospital HM Sant Jordi, Barcelona, Spain
,
Miguel Angel Pantaleon
3   Gastroenterology, Hospital del Mar, Barcelona, Spain (Ringgold ID: RIN16548)
,
Fernando Sábado 
4   Gastroenterology, Consorcio Hospitalario Provincial de Castelló, Castellón, Spain
,
Cátia Arieira 
5   Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
,
Elena Pérez Arellano
6   Gastroenterology, Hospital Universitario La Zarzuela, Madrid, Spain (Ringgold ID: RIN207202)
,
José Cotter
5   Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
7   School of Medicine, Universidade do Minho, Life and Health Sciences Research Institute (ICVS), Braga/Guimarães, Portugal
8   Gastroenterology, ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
,
David Carral
9   Gastroenterology, Hospital San Rafael, A Coruña, Spain
,
Carmen Turbí Disla
10   Medical Affairs, Norgine, Harefield, United Kingdom of Great Britain and Northern Ireland
,
Ricardo Gorjão
11   Gastroenterology, Hospital CUF Descobertas, Lisboa, Portugal
,
Jose Miguel Esteban
12   Gastroenterology, Hospital Clínico Universitario San Carlos, Madrid, Spain
,
Sarbelio Rodriguez
13   Gastroenterology, Hospital Ruber Juan Bravo, Madrid, Spain
› Author Affiliations
Supported by: Norgine Clinical Trial: Registration number (trial ID): NCT05174845, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Observational, retrospective, multicenter
› Further Information
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Abstract

Background and study aims

Clinical trials and real-world studies show a 1L polyethene glycol and ascorbic acid solution (1L PEG-ASC) to be an effective and safe bowel preparation for colonoscopy in the general population. Here, the effectiveness and safety of 1L PEG-ASC were evaluated in patients aged 80 years or older in a real-world setting.

Patients and methods

A post-hoc analysis of an observational, multicenter, retrospective study assessed the effectiveness and safety of 1L PEG-ASC on outpatients aged ≥ 80 years old undergoing colonoscopy at eight centers in Spain and Portugal. Cleansing quality was assessed using the Boston Bowel Preparation Scale, with overall scores ≥ 6 and all segmental scores ≥ 2 considered adequate colon cleansing, and overall scores ≥ 8 or 3 in the right colon considered high-quality cleansing. Cecal intubation rate, withdrawal time, polyp and adenoma detection rates (ADR), and adverse events (AEs) were also monitored.

Results

Data were analyzed from 423 patients aged ≥ 80 years; mean age 83.5 years (±3.2) and 49.2% males. The adequate colon cleansing success rate was 88.9%, with high-quality cleansing of the overall and right colon achieved in 54.1% and 46.1% of patients, respectively. Colonoscopy was complete in 94.1% of cases and the ADR was 51.3%. At least one AE was experienced by 4.5% of participants, the most frequent being mild dehydration (2.8%) and nausea (1.2%).

Conclusions

This post-hoc analysis confirms 1L PEG-ASC to be an effective and safe bowel cleansing preparation for patients aged 80 years or older in a real-world setting.

Keywords

Quality and logistical aspects - Preparation - Endoscopy Small Bowel - Performance and complications


Publication History

Received: 26 September 2024

Accepted after revision: 15 January 2025

Accepted Manuscript online:
27 January 2025

Article published online:
26 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Salvador Machlab, Vicente Lorenzo-Zúñiga, Miguel Angel Pantaleon, Fernando Sábado, Cátia Arieira, Elena Pérez Arellano, José Cotter, David Carral, Carmen Turbí Disla, Ricardo Gorjão, Jose Miguel Esteban, Sarbelio Rodriguez. Real-world effectiveness and safety of 1L polyethylene glycol and ascorbic acid for bowel preparation in patients aged 80 years or older. Endosc Int Open 2025; 13: a25259938.
DOI: 10.1055/a-2525-9938
 

  • References

  • 1 Levin B, Lieberman DA, McFarland B. et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008; 58: 130-160
    Search in Google Scholar
  • 2 Siegel RL, Wagle NS, Cercek A. et al. Colorectal cancer statistics, 2023. CA Cancer J Clin 2023; 73: 233-254
    Search in Google Scholar
  • 3 Lin OS. Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits. World J Gastrointest Endosc 2014; 6: 220-226
    Search in Google Scholar
  • 4 Lukens FJ, Loeb DS, Machicao VI. et al. Colonoscopy in octogenarians: a prospective outpatient study. Am J Gastroenterol 2002; 97: 1722-1725
    Search in Google Scholar
  • 5 Lagares-Garcia JA, Kurek S, Collier B. et al. Colonoscopy in octogenarians and older patients. Surg Endosc 2001; 15: 262-265
    Search in Google Scholar
  • 6 Sardinha TC, Nogueras JJ, Ehrenpreis ED. et al. Colonoscopy in octogenarians: a review of 428 cases. Int J Colorectal Dis 1999; 14: 172-176
    Search in Google Scholar
  • 7 Loffeld RJLF, Liberov B, Dekkers PEP. Yearly diagnostic yield of colonoscopy in patients aged 80 years or older, with a special interest in colorectal cancer. Geriatr Gerontol Int 2012; 12: 298-303
    Search in Google Scholar
  • 8 Syn W-K, Tandon U, Ahmed MM. Colonoscopy in the very elderly is safe and worthwhile. Age Ageing 2005; 34: 510-513
    Search in Google Scholar
  • 9 Arora A, Singh P. Colonoscopy in patients 80 years of age and older is safe, with high success rate and diagnostic yield. Gastrointest Endosc 2004; 60: 408-413
    Search in Google Scholar
  • 10 Shafrir A, Koslowsky B, Wengrower D. et al. Colonoscopy in nonagenarians is safe and may be associated with clinical benefit. J Am Geriatr Soc 2019; 67: 1158-1163
    Search in Google Scholar
  • 11 Day LW, Kwon A, Inadomi JM. et al. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc 2011; 74: 885-896
    Search in Google Scholar
  • 12 Khan S, Ahmed J, Lim M. et al. Colonoscopy in the octogenarian population: diagnostic and survival outcomes from a large series of patients. Surgeon 2011; 9: 195-199
    Search in Google Scholar
  • 13 Yoong KKY, Heymann T. Colonoscopy in the very old: why bother?. Postgrad Med J 2005; 81: 196-197
    Search in Google Scholar
  • 14 Travis AC, Pievsky D, Saltzman JR. Endoscopy in the elderly. Am J Gastroenterol 2012; 107: 1494-1502
    Search in Google Scholar
  • 15 Sulz MC, Kröger A, Prakash M. et al. Meta-analysis of the effect of bowel preparation on adenoma detection: Early adenomas affected stronger than advanced adenomas. PLoS One 2016; 11: e0154149
    Search in Google Scholar
  • 16 Shahini E, Sinagra E, Vitello A. et al. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature. World J Gastroenterol 2023; 29: 1685-1707
    Search in Google Scholar
  • 17 Izzy M, Malieckal A, Little E. et al. Review of efficacy and safety of laxatives use in geriatrics. World J Gastrointest Pharmacol Ther 2016; 7: 334
    Search in Google Scholar
  • 18 Bisschops R, Manning J, Clayton LB. et al. Colon cleansing efficacy and safety with 1 L NER1006 versus 2 L polyethylene glycol + ascorbate: a randomized phase 3 trial. Endoscopy 2019; 51: 60-72
    Search in Google Scholar
  • 19 DeMicco MP, Clayton LB, Pilot J. et al. Novel 1 L polyethylene glycol-based bowel preparation NER1006 for overall and right-sided colon cleansing: a randomized controlled phase 3 trial versus trisulfate. Gastrointest Endosc 2018; 87: 677-687 e3
    Search in Google Scholar
  • 20 Schreiber S, Baumgart DC, Drenth JPH. et al. Colon cleansing efficacy and safety with 1 L NER1006 versus sodium picosulfate with magnesium citrate: a randomized phase 3 trial. Endoscopy 2019; 51: 73-84
    Search in Google Scholar
  • 21 Maida M, Sinagra E, Morreale GC. et al. Effectiveness of very low-volume preparation for colonoscopy: A prospective, multicenter observational study. World J Gastroenterol 2020; 26: 1950-1961
    Search in Google Scholar
  • 22 Bednarska O, Nyhlin N, Schmidt PT. et al. The effectiveness and tolerability of a very low-volume bowel preparation for colonoscopy compared to low and high-volume polyethylene glycol-solutions in the real-life setting. Diagnostics (Basel) 2022; 12: 1155
    Search in Google Scholar
  • 23 López-Jamar JME, Gorjão R, Cotter J. et al. Bowel cleansing effectiveness and safety of 1L PEG + Asc in the real-world setting: Observational, retrospective, multicenter study of over 13000 patients. Endosc Int Open 2023; 11: E785-E793
    Search in Google Scholar
  • 24 Eurostat. Mortality and life expectancy statistics (Data extracted in March 2024). https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Mortality_and_life_expectancy_statistics
  • 25 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United European Gastroenterol J 2017; 5: 309-334
    Search in Google Scholar
  • 26 Clark BT, Laine L. High-quality bowel preparation is required for detection of sessile serrated polyps. Clin Gastroenterol Hepatol 2016; 14: 1155-1162
    Search in Google Scholar
  • 27 Hassan C, Manning J, Álvarez González MA. et al. Improved detection of colorectal adenomas by high-quality colon cleansing. Endosc Int Open 2020; 8: E928-E937
    Search in Google Scholar
  • 28 Maida M, Ventimiglia M, Facciorusso A. et al. Effectiveness and safety of 1-L PEG-ASC versus other bowel preparations for colonoscopy: A meta-analysis of nine randomized clinical trials. Dig Liver Dis 2023; 55: 1010-1018
    Search in Google Scholar
  • 29 Michalopoulos G, Tzathas C. Serrated polyps of right colon: guilty or innocent?. Ann Gastroenterol 2013; 26: 212-219
    Search in Google Scholar
  • 30 Burgess NG, Pellise M, Nanda KS. et al. Clinical and endoscopic predictors of cytological dysplasia or cancer in a prospective multicentre study of large sessile serrated adenomas/polyps. Gut 2016; 65: 437-446
    Search in Google Scholar
  • 31 Wieszczy P, Bugajski M, Januszewicz W. et al. Comparison of quality measures for detection of neoplasia at screening colonoscopy. Clin Gastroenterol Hepatol 2023; 21: 200-209 e6
    Search in Google Scholar
  • 32 Francis DL, Rodriguez-Correa DT, Buchner A. et al. Application of a conversion factor to estimate the adenoma detection rate from the polyp detection rate. Gastrointest Endosc 2011; 73: 493-497
    Search in Google Scholar
  • 33 Kaminski MF, Wieszczy P, Rupinski M. et al. Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death. Gastroenterology 2017; 153: 98-105
    Search in Google Scholar
  • 34 Sullivan BA, Noujaim M, Roper J. Cause, epidemiology, and histology of polyps and pathways to colorectal cancer. Gastrointest Endosc Clin N Am 2022; 32: 177-194
    Search in Google Scholar
  • 35 Machlab S, Francia E, Mascort J. et al. Risks, indications and technical aspects of colonoscopy in elderly or frail patients. Position paper of the Societat Catalana de Digestologia, the Societat Catalana de Geriatria i Gerontologia and the Societat Catalana de Medicina de Familia i Comunitaria. Gastroenterol Hepatol 2024; 47: 107-117
    Search in Google Scholar
  • 36 Compagna R, Serra R, Sivero L. et al. Tailored treatment of intestinal angiodysplasia in elderly. Open Med (Wars) 2015; 10: 538-542
    Search in Google Scholar
  • 37 Cha JM, Kozarek RA, Selva DL. et al. Risks and benefits of colonoscopy in patients 90 years or older, compared with younger patients. Clin Gastroenterol Hepatol 2016; 14: 80-86 e1
    Search in Google Scholar
  • 38 Baxter NN, Sutradhar R, Forbes SS. et al. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology 2011; 140: 65-72
    Search in Google Scholar