Title:Lower Gastrointestinal Bleeding in the Emergency Department: High-
Volume vs. Low-Volume Peg Bowel Preparation for Colonoscopy: A
Randomized Trial
Volume: 18
Issue: 1
Author(s): Angela Saviano, Carmine Petruzziello, Maria Elena Riccioni, Marcello Di Pumpo, Martina Petrucci, Mattia Brigida, Christian Zanza, Marcello Candelli, Francesco Franceschi and Veronica Ojetti*
Affiliation:
- Emergency Department, Fondazione Policlinico A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
Keywords:
Colonoscopy, emergency department, BBPS, lower gastrointestinal bleeding, 2L-PEG, 4L-PEG.
Abstract:
Background: Lower Gastrointestinal Bleeding (LGIB) is a common cause of
admission to the Emergency Department (ED). Early colonoscopy is the exam of choice for
evaluating LGIB, and an adequate colon cleansing is essential. High-volume solution 4L-PEG is
largely used, but it has some limitations. Low-volume solution 2L-PEG may improve patient’s
tolerability and compliance, reducing the time of administration and speeding up the exam.
Patients and Methods: We conducted a randomized 1:1, prospective observational monocentric
study in 228 patients (144M/84F) with LGIB. 121 (69M/52F) received the High-Volume, while
107 (75M/32F) received Low-Volume. They completed a “satisfaction questionnaire” (taste and
smell, mood, time of taking, general experience). We collected the results of the Boston Bowel
Preparation Scale (BBPS) and the final diagnosis.
The study was retrospectively registered on clinicaltrial.gov with protocol number NCT0536
2227.
Results: A mean value of BBPS 6,3 was achieved by both groups (p=0.57). Regarding smell,
taste, mood and time of taking (1 to 5), we do not find any statistically differences. The overall
satisfaction between the two preparations was 2.90 for low-volume compared to 3.17 for Highvolume
(p=0.06). No side effects were reported. The proportion of patients without an evident
source of bleeding was higher in High volume preparations compared to Low-volume (39% vs.
30%, respectively).
Conclusion: Low volume bowel preparation showed the same efficacy and tolerability with
better satisfaction compared with high volume. Low-volume could represent an effective and
more desirable preparation for patients in the ED.
