P506. Efficacy and safety of two bowel preparations for colonoscopy in IBD patients
I. Frankovic1, M. Martinato1, C. Mescoli2, R. Caccaro1, A.C. Frigo3, M. Rugge2, G.C. Sturniolo1, R. D'Incà1, 1Padua, Surgical, Gastroenterological and Oncological Sciences, Padua, Italy, 2Padua, Diagnostic, Medical Sciences and Special Therapies, Surgical Pathology and Cytopathology Unit, Padua, Italy, 3Padua, Environmental Medicine and Public Health, Padua, Italy
Bowel preparation is essential for an adequate colonoscopic examination. Inflammatory bowel disease (IBD) patients perform colonoscopy many times during their lifespan. Few data are available regarding the safety of bowel cleansing preparations in IBD patients especially regarding disease relapse after their use. We also miss data regarding efficacy, acceptability and tolerability that represent an important issue for the patients. Aim of the study was to compare safety, efficacy, acceptability and tolerability of two bowel cleansing preparations (PEG - polyethylene glycol and PICO - sodium picosulphate plus magnesium citrate) for colonoscopy in IBD patients.
Our pilot study enrolled 56 patients with IBD (34 with ulcerative colitis and 22 with Crohn's disease) in clinical remission that underwent colonoscopy and were assigned to receive either PEG or PICO. Safety was evaluated biochemically before, immediately after preparation and 20 days later. The amount of mucosal damage was evaluated blindly by the pathologist. Efficacy was assessed blindly by the endoscopist using the Ottawa scale. Patients completed a questionnaire about acceptability of the preparation. Tolerability was recorded in a clinical diary.
Two patients (one in each group) had mild disease relapse after colonoscopy which didn't require major therapeutic adjustment. No clinically significant changes were observed in serum urea and electrolytes. Efficacy was better in the PEG with respect to the PICO group (p = 0.03), and this was due mainly to a better effectiveness in the right colon cleansing (p = 0.016). However, a complete exploration of the colon was possible in all the patients. PICO was more acceptable in terms of easiness of assumption, taste and possible re-use of the same preparation compared to PEG. Tolerability was similar in the two groups.
IBD patients can adopt both preparations since PEG and PICO showed a similar safety profile. PEG offers better colon cleansing especially in the right colon but patient's preference goes to PICO.