Colonoscopy in octogenarians and older patients with 1L polyethylene glycol plus ascorbic acid bowel preparation in the real-world setting

Aims Colonoscopy for colorectal cancer (CRC) detection in octogenarians is technically challenging due to bowel preparation difficulties in this population. Poor preparation quality is reported in 25% patients [ 1 ]. This may be due in part to difficulties in completing the bowel preparation. Specific data on bowel preparation with 1L polyethylene glycol plus ascorbic acid (1L PEG+ASC) is lacking in patients aged≥80 years. We therefore aimed to evaluate the colon cleansing effectiveness and tolerability of 1L PEG+ASC in this population. Methods This was a post-hoc analysis of an observational, multicentre, retrospective real-world study that included outpatients aged≥80 years, who received 1L PEG+ASC before undergoing colonoscopy in 8 centres in Spain and Portugal between July 2019 and September 2021 [ 2 ]. Cleansing quality was evaluated using the Boston Bowel Preparation Scale (BBPS). Adequate quality was defined as a BBPS score≥6 with all segmental scores≥2. High-quality cleansing was defined as a BBPS score≥8 with a segmental score of 3 in the right colon. Cecal intubation rate (CIR), withdrawal time (WT), and polyp detection rate (PDR) were also assessed. Safety was assessed from recorded adverse events (AEs). Results A total of 423 patients (49.2% male) were included. Their mean age was 83.5 years (range 80 to 95 years). The indication for colonoscopy was screening for colorectal cancer (14.4%), diagnostic (56.7%), follow-up (25.5%), or other (3.3%). The bowel preparation method was either as a split-dose (40.9%) or a same-day dose (59.1%) regimen. In total, 94.1% of patients completed the colonoscopy. Incomplete colonoscopy was reported in 5.9% of patients, including 1% due to poor preparation, 1.4% due to stenosing cancer, 1.2% due to technical difficulties, and 2.3% for other reasons. Adequate cleansing in the overall colon was achieved in 88.9% of patients with an overall high-quality colon cleansing rate of 54.1%. In the right colon, adequate and high-quality cleansing were achieved in 90.5% and 46.1% patients, respectively. CIR was 94.9%, with a mean WT of 8.4 minutes and the PDRs in the total colon and right colon were 45.6% and 26.7%, respectively. The incidence of AEs in was 4.5%, with dehydration (2.8%) and nausea (1.2%) being the most reported AEs. No severe AEs were reported. Conclusions Overall, these real-world data in octogenarians and older patients indicate that 1L PEG+ASC was highly effective and well tolerated, with over half of patients attaining high-quality total colon cleansing. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany