title: Overall acceptability and efficacy of commonly used bowel preparations for colonoscopy in Italian clinical practice. A multicentre prospective study.
abstract: OBJECTIVE
  The recent enormous increase in colonoscopy demand prompted this multicentre observational study assessing overall acceptability and efficacy of commonly used bowel preparations in Italian clinical practice.
  
  
  METHODS
  Consecutive outpatients undergoing colonoscopy were recruited from 9 major gastroenterological centres in Italy. Each patient evaluated overall acceptability of the bowel cleansing preparation through a 0-100mm Visual Analogue Scale. The Visual Analogue Scale score was dichotomized by a median split: 80-100 (high acceptability) vs. 0-79 (low acceptability). Bowel cleansing was assessed through a validated scale. The influence of potential individual determinants on patients' acceptability and cleansing efficacy of the bowel preparations was determined by multivariate analyses.
  
  
  RESULTS
  599 evaluable patients were enrolled; 57.3% received 4L-PEG preparations, 29.5% 2L-PEG preparations and 13.2% 2-glasses-solutions (Na-phosphate/Mg-citrate/Na-picosulphate-containing preparations). Overall acceptability was significantly higher for 2L-PEG and 2-glasses solutions than 4L-PEG (adjusted odds ratio, 4.72; and adjusted odds ratio 2.07, respectively). Successful bowel cleansing achieved with 4L-PEG (85.9%) was similar to 2L-PEG (85.3%; adjusted odds ratio 0.82) and significantly higher than 2-glasses solutions (69.6%; adjusted odds ratio 0.34 vs. 4L-PEG). Split regimen, lower total preparation volume and colonoscopy reason (periodical control vs. 1st procedure) were significantly associated with high acceptability. Age ≥60 years, dissatisfaction with the preparation taken, and ≤4/week bowel movements were major determinants of a poor bowel cleansing.
  
  
  CONCLUSIONS
  2L-PEG and 4L-PEG preparations provide the most effective bowel cleansing for colonoscopy in clinical practice, with a significantly higher acceptability for 2L-PEG preparations.
authors.affiliation: Gastroenterological Units, Ospedale A. Manzoni, Lecco, Italy. Electronic address: f.parente@ospedale.lecco.it.
authors.forename: Fabrizio Raffaello
authors.initials: FR
authors.lastname: Parente
authors.affiliation: IRCCS Humanitas, Rozzano, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.affiliation: Istituto Europeo di Oncologia, Milano, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Crosta
authors.affiliation: Ospedale Maresca, Torre del Greco, Italy.
authors.forename: Livio
authors.initials: L
authors.lastname: Cipolletta
authors.affiliation: IRCCS San Raffaele, Milano, Italy.
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Testoni
authors.affiliation: Policlinico A. Gemelli, Roma, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.affiliation: IRCCS Casa del Sollievo e della Sofferenza, San Giovanni Rotondo, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Andriulli
authors.affiliation: Ospedale S. De Bellis, Castellana Grotte, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Matteo
authors.affiliation: Azienda Ospedaliera di Reggio Emilia, Italy.
authors.forename: Remo
authors.initials: R
authors.lastname: Sassatelli
authors.affiliation: Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Gallus
mesh_terms: D000368:Aged; D002400:Cathartics / Q000494:pharmacology*; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D002400:Cathartics
keywords: Acceptability; Bowel cleansing preparations; Cleansing efficacy; Colonoscopy