title: Morning-only polyethylene glycol is noninferior but less preferred by hospitalized patients as compared with split-dose bowel preparation.
abstract: OBJECTIVE
  To compare the efficacy and tolerability of morning-only polyethylene glycol (PEG) with split-dose preparation in hospitalized patients scheduled for colonoscopy.
  
  
  BACKGROUND
  Morning-only colonoscopy preparation may improve efficiency by allowing patient preparation and colonoscopy to be performed on the same day. There are limited data comparing morning-only with split-dose preparation, and more studies are needed before morning-only preparation can be routinely recommended.
  
  
  METHODS
  A single-center, prospective, endoscopist-blinded study was conducted, in which hospitalized patients scheduled to undergo diagnostic colonoscopy were randomly assigned to receive 4 L of PEG either on the morning of colonoscopy or as a split-dose (evening-morning). The primary endpoint was efficacy of bowel preparation measured by the Ottawa scale. Secondary endpoints were patient compliance and tolerance.
  
  
  RESULTS
  A total of 120 hospitalized patients scheduled for diagnostic colonoscopy were randomized. The mean total Ottawa score was slightly superior for the morning-only arm, and the upper bound of 95% confidence interval (CI) for difference between arms was less than our prespecified noninferiority margin of 1.5 (difference=-0.23; 95% CI, -1.72 to 1.25). The percentage of patients with good bowel preparation was similar for all colonic segments. There was a trend toward more side effects among patients in the morning-only compared with the split-dose arm (71% vs. 54%; P=0.08). Compared with morning-only preparation, more patients in the split-dose arm were willing to undergo similar preparation for future colonoscopies (71% vs. 89%; P=0.02).
  
  
  CONCLUSIONS
  Morning-only PEG is not inferior to split-dose preparation regarding bowel cleansing efficacy for colonoscopy in hospitalized patients. However, split-dose preparation was preferred by patients because of less side effects.
authors.affiliation: *Division of Gastroenterology †Department of Medicine ‡Collaborative Research Unit, Department of Medicine, John H Stroger Jr Hospital of Cook County, Chicago, IL.
authors.forename: Vikram S
authors.initials: VS
authors.lastname: Kotwal
authors.forename: Bashar M
authors.initials: BM
authors.lastname: Attar
authors.forename: Mauricio D
authors.initials: MD
authors.lastname: Carballo
authors.forename: Salina S
authors.initials: SS
authors.lastname: Lee
authors.forename: Tarun
authors.initials: T
authors.lastname: Kaura
authors.forename: Benjamin
authors.initials: B
authors.lastname: Go
authors.forename: Huiyuan
authors.initials: H
authors.lastname: Zhang
authors.forename: William E
authors.initials: WE
authors.lastname: Trick
mesh_terms: D000328:Adult; D000368:Aged; D002400:Cathartics / Q000008:administration & dosage* / Q000009:adverse effects; D003106:Colon; D003113:Colonoscopy / Q000379:methods*; D004334:Drug Administration Schedule; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D057240:Patient Preference; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D002400:Cathartics; D011092:Polyethylene Glycols