番茄社区

The low-volume bowel preparation MoviPrep provided a noninferior alternative to the standard high-volume GoLYTELY in a cohort of hospitalized patients undergoing colonoscopy, a randomized trial showed.

Of the 412 patients analyzed, 55% in the MoviPrep group had adequate bowel preparation compared with 52.9% of those in the GoLYTELY group (P=0.007), reported Karen Xiao, MD, of Yale School of Medicine in New Haven, Connecticut, at the American College of Gastroenterology annual meeting in Philadelphia.

"MoviPrep may be appropriate as an alternative to traditional high-volume bowel preparation in hospitalized patients undergoing colonoscopy," Xiao said, with patients in the MoviPrep group reporting "higher tolerability and willingness to repeat colonoscopy preparation in the future."

Significantly more patients found MoviPrep to be "easy" (29%) or "acceptable" (39.8%) compared with GoLYTELY (13.1% and 30.2%, respectively; P<0.001). Moreover, more patients who used MoviPrep said they would be "mostly willing" to use the same prep again (49.7%) versus patients who used GoLYTELY (33.7%; P=0.01).

Past research has shown low-volume bowel prep to as high-volume prep, but that was in non-hospitalized patients. About 20% to 50% of inpatient colonoscopies have inadequate bowel preparation, Xiao told attendees.

"Risk factors for inadequate bowel preparation include the setting, as well as patient-specific factors, such as the presence of comorbidities like constipation and diabetes, and the use of certain medications, such as tricyclic antidepressants and opioids," Xiao said. "There are bowel preparation-related factors as well, such as the volume of preparation, the timing of the preparation, [and] education surrounding the preparation."

The current standard of care for inpatients undergoing colonoscopy is high-volume polyethylene glycol electrolyte lavage (PEG-ELS), but patients generally prefer low-volume regimens to high-volume ones, she noted.

"I am struck by the consistently poor bowel preps among hospitalized patients regardless of agent used," Rachel Issaka, MD, MAS, director of the Population Health Colorectal Cancer Screening Program at the University of Washington School of Medicine in Seattle, told 番茄社区.

"In outpatient settings we aim for 90% adequate bowel preps, and in this study, we see that these rates are barely over 50% in those who are hospitalized," Issaka said. "This study highlights the importance of improving the quality of bowel prep adequacy among hospitalized patients and the need for close outpatient follow-up for those who don't achieve adequate bowel preps while hospitalized."

For this trial, the researchers compared bowel preparation outcomes in 412 hospitalized patients at two sites in the Yale-New Haven Health System, with 202 randomly assigned to use MoviPrep (polyethylene glycol and ascorbic acid) and 210 assigned to GoLYTELY (polyethylene glycol and electrolytes). The primary outcome was a Boston Bowel Preparation Score of at least 6, with a score of at least 2 in all segments. Patients were excluded if they had a prior bowel resection, foreign body removal, or a medical contraindication.

Mean patient age was 62, 58-60% were men, two-thirds were white, and 16-25% had a body mass index of 30 or higher. Most patients had an American Society of Anesthesiologists score of 3 (65-67%) or 4 (20-21%). The most common comorbidities were diabetes (25-34%), chronic heart failure (21-25%), chronic kidney disease (21%), atrial fibrillation (19-22%), and cirrhosis (13-14%).

Most (70-74%) were taking antihypertensives, 42-48% were taking antithrombotics, and 27-31% were receiving opioids. Gastrointestinal bleeding was the indication for a colonoscopy in 55% of the patients, with other causes that included surveillance, abdominal pain, inflammatory bowel disease, diarrhea, malignancy, and other causes.

In other secondary outcomes, there were no significant differences between the MoviPrep and GoLYTELY groups in terms of hospital length of stay (median 6 days for both, P=0.28), time to colonoscopy (median 17.1 vs 17.6 hours, P<0.01), or cecal intubation rate (94.6% vs 95.7%, P=0.8).

Adverse events were also similar between the MoviPrep and GoLYTELY groups, including hyponatremia (1.6% vs 3.3%), hypernatremia (3.2% vs 0.5%), hypokalemia (5.3% vs 8.7%), hyperkalemia (1.1% vs 0%), and acute kidney injury (4.3% vs 3.3%).

Responding to a question from attendees, Xiao acknowledged that another difference between the preps is that MoviPrep costs somewhere between three to seven times more than GoLYTELY, depending on insurance.

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