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Real-world comparison of the effectiveness and safety of different bowel preparation agents

Authors Sacks NC, Sharma A, Cyr PL, Bertiger G, Dahdal DN, Brogadir SP

Received 21 April 2018

Accepted for publication 4 July 2018

Published 16 August 2018 Volume 2018:11 Pages 289—299


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Everson L.A. Artifon

Naomi C Sacks,1,2 Abhishek Sharma,1 Philip L Cyr,1,3 Gerald Bertiger,4 David N Dahdal,5 Stuart P Brogadir5

1Precision Xtract, Boston, MA, USA; 2Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 3College of Health and Human Services, University of North Carolina, Charlotte, NC, USA; 4Hillmont GI, Flourtown, PA, USA; 5Ferring Pharmaceuticals Inc., Parsippany, NJ, USA

Background and aims: Proper bowel cleansing is necessary prior to colonoscopy, but poor tolerability to bowel preparation agents may increase the odds of poor cleansing and incomplete screenings. The aim of this study was to evaluate the real-world effectiveness and safety of bowel preparation agents.
Methods: Claims data were extracted for individuals who had a screening colonoscopy from July 1, 2012, to June 30, 2015, were ≥18 years of age, and who could be observed ≥6 months before and ≥3 months after the screening. Data were stratified by agent class, including over-the-counter (OTC), low-volume (LV), and high-volume (HV) agents. Rates of incomplete screenings, repeat screenings, and hospitalizations were reported. Multivariate logistic regression was conducted to compare outcomes for sodium picosulfate, magnesium oxide, and citric acid (P/MC) vs other agents.
Results: Of 2.8 million individuals, 71.5% were average risk and 28.5% were high risk for colorectal cancer. Rates of use were 2.8% for P/MC, 30.1% for other LV agents, 9.4% for HV agents, and 56.6% for OTC agents. All individuals who used P/MC had significantly lower odds of incomplete screenings compared to those who used other LV agents or HV agents (P<0.05). In average-risk patients, rates of 30- and 90-day repeat screenings were highest for the P/MC group (16.7% and 23.0%, respectively) compared to other agents. Across all patient analysis groups, the rates of hospitalizations for hyponatremia or dehydration were much higher for those who used an OTC bowel preparation agent compared to those who used LV or HV agents, or P/MC.
Conclusion: P/MC was associated with lower rates of incomplete colonoscopy and higher rates of repeat screenings, suggesting it was better tolerated than other agents. OTC agents were associated with higher rates of hospitalizations.

Keywords: colonoscopy, colorectal cancer screening, bowel purgative, bowel preparation, incomplete colonoscopy

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