title: Split dosing with a low-volume preparation is not inferior to split dosing with a high-volume preparation for bowel cleansing in patients with a history of colorectal resection: a randomized trial.
abstract: OBJECTIVE
  The study compared the efficacy of bowel cleansing using a low-volume mixed preparation (15 mg bisacodyl plus 2 L polyethylene glycol [PEG] solution) versus a standard high-volume preparation (4 L PEG) in patients with previous colorectal resection.
  
  
  METHODS
  A total of 120 patients with prior colorectal resection for cancer undergoing surveillance colonoscopy were randomized to receive either a split-dose low-volume (n = 60) or high-volume (n = 60) preparation for bowel cleansing. The quality of bowel preparation, rated according to a modified Ottawa Bowel Preparation scale (mOBPS), represented the primary outcome measure. Tolerability, safety, and lesion detection rates were secondary outcomes.
  
  
  RESULTS
  No significant difference was observed between the low-volume and high-volume preparations in achievement of adequate cleansing (i. e. mOBPS ≤ 4; low-volume vs. high-volume group, 85.0 % vs. 81.7 %, P = 0.624). The low-volume preparation showed a higher success rate for cleansing of the right colon (P = 0.025); better tolerability in terms of intake of the whole amount of the preparation (P < 0.001) was also observed. According to the logistic regression analysis, the only predictors of unsuccessful cleansing were previous left colectomy (P = 0.012) and a longer elapsed time since the intervention (P = 0.034). Lesion detection rates were comparable between the groups. No serious adverse events were reported.
  
  
  CONCLUSIONS
  A low-volume preparation is not inferior to a high-volume preparation for adequate bowel cleansing in patients with prior colorectal resection for cancer. If larger, multicenter, prospective studies confirm our findings, a low-volume preparation will represent a more tolerable option for such patients.
  
  
  BACKGROUND
  ClinicalTrial.gov identifier NCT01887158.
authors.affiliation: Division of Gastroenterology, S. Maria delle Croci Hospital, Ravenna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mussetto
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Frazzoni
authors.affiliation: Division of Endoscopy, Valduce Hospital, Como, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Paggi
authors.affiliation: Division of Gastroenterology, S. Maria delle Croci Hospital, Ravenna, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Dari
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Liboria
authors.initials: L
authors.lastname: Laterza
authors.affiliation: Division of Endoscopy, Valduce Hospital, Como, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Radaelli
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Division of Gastroenterology, S. Maria delle Croci Hospital, Ravenna, Italy.
authors.forename: Omero
authors.initials: O
authors.lastname: Triossi
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fuccio
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001726:Bisacodyl / Q000008:administration & dosage*; D002400:Cathartics / Q000008:administration & dosage*; D019343:Citric Acid / Q000008:administration & dosage*; D003082:Colectomy; D003106:Colon / Q000187:drug effects*; D003113:Colonoscopy / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011184:Postoperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D016037:Single-Blind Method
chemical_list: D002400:Cathartics; D004338:Drug Combinations; D001726:Bisacodyl; D019343:Citric Acid; D011092:Polyethylene Glycols