Optimal Bowel Preparation Regimen in Patients With Colorectal Surgery

Overview

The study compares the efficacy of bowel cleansing between the standard preparation (2 L polyethylene glycol electrolyte solution, 2 L PEG-ELS), low-volume preparation (10 mg bisacodyl plus 2 L PEG-ELS) and high-volume preparation (4 L PEG-ELS) in patients with previous colorectal resection.

Full Title of Study: “Optimal Bowel Preparation Regimen for Patients With With a History of Colorectal Resection Before Colonoscopy”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Investigator)
  • Study Primary Completion Date: November 2016

Detailed Description

Colonoscopy is the standard approach for evaluating the colon currently. Thorough bowel cleansing is critical for adequate visualization of colonic mucosa during colonoscopy. Inadequate bowel cleansing results in adverse consequences for the examination, including lower adenoma detection rates, longer procedural time, lower cecal intubation rates, shorter intervals between examinations and an estimated 12-22% increase in overall colonoscopy cost. A history of colorectal resection represents an independent predictor for inadequate colon cleansing,hence strategies to improve bowel preparation may be a demanding goal in this subset of patients. The study compares the efficacy of bowel cleansing between the standard preparation (2 L polyethylene glycol electrolyte solution, 2 L PEG-ELS), low-volume preparation (10 mg bisacodyl plus 2 L polyethylene glycol electrolyte solution) and high-volume preparation (4L polyethylene glycol electrolyte solution, 4L PEG-ELS) in patients with previous colorectal resection. Then the investigators can select the optimized regimen for patients with colorectal surgery.

Interventions

  • Drug: standard preparation (2L PEG-ELS)
    • Subjects who are randomized into group A will receive standard bowel preparation (2L PEG-ELS) on the same-day of procedure.
  • Drug: low-volume preparation (10 mg bisacodyl plus 2L PEG-ELS)
    • Subjects who are randomized into group B will receive 10mg bisacodyl at 6 pm on the evening before the colonoscopy and 2L PEG-ELS on the same-day of procedure.
  • Drug: high-volume preparation (4L PEG-ELS)
    • Subjects who are randomized into group C will receive 2L PEG at 6 pm before the procedure and another 2L PEG-ELS on the same-day of procedure.(4L PEG)

Arms, Groups and Cohorts

  • Active Comparator: GroupA:standard preparation
    • Subjects who are randomized into group A receive standard bowel preparation (2L PEG-ELS) on the same-day of procedure.
  • Experimental: Group B:low-volume preparation
    • Subjects who are randomized into group B receive 10mg bisacodyl at 6 pm on the evening before the colonoscopy and 2L PEG-ELS on the same-day of procedure. ( 2L PEG-ELS and 10mg bisacodyl )
  • Experimental: Group C:high-volume preparation
    • Subjects who are randomized into group C will receive 2L PEG-ELS at 6 pm before the procedure and another 2L PEG-ELS on the same-day of procedure. (4 L PEG-ELS)

Clinical Trial Outcome Measures

Primary Measures

  • Difference of scores rating by Aronchick Preparation Scale among 3 groups.
    • Time Frame: 6 months
    • This is an established rating scale to evaluate the quality of bowel prep. The ratings will be compared among the 3 groups.

Secondary Measures

  • Rate of compliance with instructions among 3 groups
    • Time Frame: 6 months
    • Compliance was scored on a 3-grade scale based on the intake of bowel solution: 0 = optimal (intake of 100% of the solution); 1 = good (intake of ≥75% of the solution); 2 = poor (intake of <75% of the solution).
  • Willingness to repeat bowel preparation among 3 groups.
    • Time Frame: 6 months
    • the willingness to repeat the same bowel preparation,a patient’s subjective evaluation of the bowel preparation was recorded by a questionnaire
  • Polyp detection rate among 3 groups.
    • Time Frame: 6 months
    • Polyp detection rate was defined as the proportion of patients with at least one polyp.
  • Withdrawal time among 3 groups.
    • Time Frame: 6 months
    • Withdrawal time from ileocecum, not including the time of treatment and biopsy for polyps.
  • Caecal intubation rate among 3 groups.
    • Time Frame: 6 months
    • Caecal intubation rate is defined the proportion of patients with caecal intubation.

Participating in This Clinical Trial

Inclusion Criteria

  • All adults (18< age<75years) referred for surveillance colonoscopy with a history of colorectal resection for Colorectal cancer (CRC). Exclusion Criteria:

  • severe comorbidities (e.g. congestive heart failure and severe kidney disease) – abdominal and pelvic surgery other than colorectal resection for the cause of CRC. – severe colonic stricture or obstructing tumour – dysphagia – compromised swallowing reflex or mental status – significant gastroparesis or gastric outlet obstruction – known or suspected bowel obstruction or perforation – severe chronic renal failure (creatinine clearance<30 ml/min – severe congestive heart failure (New York Heart Association class III or IV) – uncontrolled hypertension (systolic blood pressure>170 mm Hg, diastolic blood pressure>100 mm Hg) – inflammatory bowel disease or megacolon – dehydration – disturbance of electrolytes – pregnancy or lactation – haemodynamically unstable – unable to give informed consent.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 75 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Shandong University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Yanqing Li, PhD, MD – Shandong University
  • Overall Official(s)
    • li yanqing, PhD,MD, Principal Investigator, Qilu Hospital, Shandong University
  • Overall Contact(s)
    • li yanqing, PhD,MD, 86-531-82169236, liyanqing@sdu.edu.cn

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