Efficacy and Safety of Low Volume Bowel Preparation for Colonoscopy in Hospitalized Patients

GOALS: To evaluate whether low-volume bowel preparation achieved similar rates of bowel cleansing as standard volume bowel preparations among hospitalized patients and assess the tolerability and safety of their use in this population. BACKGROUND: The use of low-volume bowel preparations for colonoscopy preparation is understudied in the inpatient setting, where standard volume preparations remain the standard of care. METHODS: We conducted a multicenter, randomized, single-blind, noninferiority trial. Hospitalized adult patients were randomized to receive low volume (2 L polyethylene glycol and ascorbic acid, 2L PEG+ASC) or standard volume bowel preparation (4 L polyethylene glycol and electrolyte lavage solution, 4L PEG-ELS) before colonoscopy. The primary outcome was noninferiority with respect to the achievement of adequate bowel preparation. Secondary outcomes included rates of electrolyte derangements, acute kidney injury, and patient tolerability. RESULTS: Five hundred twenty patients were randomized to 2L PEG+ASC (n=257) and 4L PEG-ELS (n=263). In per-protocol analysis, 2L PEG+ASC was noninferior to 4L PEG-ELS for achievement of adequate bowel preparation (55.0% vs. 52.9%, P =0.007). No significant difference was detected with regard to hyponatremia (1.6% vs. 3.3%, P =0.50), hypokalemia (5.3% vs. 8.7%, P =0.27), hyperkalemia (1.1% vs. 0.0% P =0.24), or acute kidney injury (4.3% vs. 3.3%, P =0.73). More 2L PEG+ASC patients found the preparation to be "easy" to tolerate compared with 4L PEG-ELS patients (29.0% vs. 13.1%, P <0.001). CONCLUSIONS: Among hospitalized patients, 2L PEG+ASC was noninferior to 4L PEG-ELS for achieving bowel cleanliness with similar rates of electrolyte disturbance and acute kidney injury and with higher tolerability (ClinicalTrials.gov number, NCT05054036).