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P093. Preparation for colonoscopy in everyday routine – what makes it successful?

D. Hueppe1, J. Labenz2, M. Varrentrapp3, S. Ceplis-Kastner4, B. Reimers4, H.‑J. Toermer5

1Gastroenterology Practice Herne, Herne, Germany; 2Diakonie Klinikum, Innere Medizin, Siegen, Germany; 3Rotkreuzklinik Wertheim, Innere Medizin, Wertheim, Germany; 4Ferring Arzneimittel GmbH, Medical Department, Kiel, Germany; 5Gastro Praxis Köln Nord, Köln, Germany

Background: Bowel cleansing prior colonoscopy widely varies in clinical routine. Besides efficacy and tolerability of the product used, patient acceptance is vital for success of colonoscopy.

Methods: The study aimed to investigate efficacy, acceptance and tolerability of a novel bowel cleansing product (Picoprep), containing only 10 mmol potassium per bowel preparation. Conventional 4‑l-PEG solutions contain 20–40 mmol, 2‑l-PEG+ascorbic acid 28.4 mmol. Furthermore, the study aimed to identify factors influencing efficacy. 177 gastroenterologists prospectively (Sept 10 – Apr 11) documented their routine use of Picoprep in standardised online questionnaires. Efficacy, tolerability and taste were scored 1 (excellent) – 6 (insufficient); 1, 2 and 3 were grouped as “good”.

Results: 1105 patients (52% female; 16–100 y, mean 55) presenting for screening (28%) or curative colonoscopy (72%) were included in an interim analysis. 30% took both Picoprep doses on the preceding day, 2% took both on the day of colonoscopy, 68% took a split dose, i.e. dose 1 on the preceding day, dose 2 on the day of colonoscopy. Efficacy in all bowel sections was assessed as good in 91% of colonoscopies, exactly as 1 (42%), 2 (33.2%), 3 (15.9%), 4 (6.8%), 5 (1.7%) and 6 (0.4%). 95% of patients reported “good” tolerability, 97% rated taste as “good”. Bowel cleansing was more effective when patients drank additionally 3–4 L of clear fluids (larger or smaller volumes had unfavourable effects). Furthermore, efficacy of bowel cleansing was influenced by time both Picoprep doses were taken. In colonoscopies scheduled before noon, highest efficacy was achieved when 1st dose was taken less than 18 h and 2nd dose approx. 4 h before the procedure. In colonoscopies scheduled after noon, optimal timing for 1st and 2nd dose was less than 20 h and 6–8 h before the procedure, respectively. Efficacy, tolerability and side effects in patients <55 years were comparable to those >55.

Conclusions: Picoprep is used very individually in clinical routine with regard to dosing times and volumes of clear fluids drunk – these factors also clearly influence efficacy. Picoprep has a good cleansing effect in all sections of the lower digestive tract. In particular, an outstanding patient acceptance makes the product suitable for bowel cleansing in preparation for preventive and curative colonoscopy. It may be preferable in patients with bad compliance or acceptance of previously taken bowel preparation agents.