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

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

• 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
• 2 Siegel RL, Wagle NS, Cercek A. et al. Colorectal cancer statistics, 2023. CA Cancer J Clin 2023; 73: 233-254
• 3 Lin OS. Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits. World J Gastrointest Endosc 2014; 6: 220-226
• 4 Lukens FJ, Loeb DS, Machicao VI. et al. Colonoscopy in octogenarians: a prospective outpatient study. Am J Gastroenterol 2002; 97: 1722-1725
• 5 Lagares-Garcia JA, Kurek S, Collier B. et al. Colonoscopy in octogenarians and older patients. Surg Endosc 2001; 15: 262-265
• 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
• 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
• 8 Syn W-K, Tandon U, Ahmed MM. Colonoscopy in the very elderly is safe and worthwhile. Age Ageing 2005; 34: 510-513
• 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
• 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
• 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
• 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
• 13 Yoong KKY, Heymann T. Colonoscopy in the very old: why bother?. Postgrad Med J 2005; 81: 196-197
• 14 Travis AC, Pievsky D, Saltzman JR. Endoscopy in the elderly. Am J Gastroenterol 2012; 107: 1494-1502
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 26 Clark BT, Laine L. High-quality bowel preparation is required for detection of sessile serrated polyps. Clin Gastroenterol Hepatol 2016; 14: 1155-1162
• 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
• 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
• 29 Michalopoulos G, Tzathas C. Serrated polyps of right colon: guilty or innocent?. Ann Gastroenterol 2013; 26: 212-219
• 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
• 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
• 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
• 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
• 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
• 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
• 36 Compagna R, Serra R, Sivero L. et al. Tailored treatment of intestinal angiodysplasia in elderly. Open Med (Wars) 2015; 10: 538-542
• 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
• 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