Factors influencing colonoscopy bowel preparation quality in patients with quiescent ulcerative colitis in endoscopic remission: a multicentre cross-sectional study

Aims Adequate bowel preparation (BP) is crucial for high-quality colonoscopy surveillance in ulcerative colitis (UC), because an inadequate one lead to incomplete colonoscopy and higher rate of missing precancerous lesions, which are usually flat or subtle in this setting. There is conflicting evidence regarding whether the disease activity or extension are risk factors for inadequate BP in patients with inflammatory bowel disease (IBD); furthermore, data on the optimal PEG-regimen to use in this setting are limited. The aim of this study was to assess which factors influence the quality of BP in this specific setting.

Methods This is a multicentre, cross-sectional, retrospective study carry out in four referral centres between January-2021 and December-2023, including quiescent UC patients with endoscopic remission (Mayo endoscopic score=0) underwent colonoscopy. Bowel preparation quality was assessed using the Boston Bowel Preparation Scale (BBPS) and performed with 1L-PEG-ASC (Plenvu) and 2L-PEG (Moviprep and Clensia), without any specific allocation or instructions. Demographic, anamnestic and endoscopic data were evaluated and analysed [1] [2].

Results Overall, 261 UC patients (F 99, 37.9%, mean age 55.6±14.5) were recruited. Patients with previous maximum extension of proctitis (E1) were 31 (12.1%), with left-sided colitis (E2) were 104 (40.6%) and with pancolitis (E3) were 121 (47.3%); additionally, patients with history of advanced therapy were 104 (39.8%). Entire cohort adequate preparation rate was 90.4%. 1L-PEG-ASC preparation showed significantly higher adequate BP rate compared to 2L-PEG preparations (93.7% vs 85.4%, p=0.032). Right colon adequate did not differ among the BPs (93.7% vs 91.3%). Patient demographics, smoking status, maximum disease extension, history of advanced therapy or presence of pseudopolyps did not significantly affect BP quality (p>0.05).

Conclusions In a relatively unbiased setting, such as quiescent UC patients in endoscopic remission, the bowel preparation volume, specifically 1L-PEG-ASC, was the primary determinant of BP quality, with neither disease extent nor history of advanced therapy affect BP. These findings suggest that 1L-PEG-ASC preparation may be the preferred option for colonoscopy BP preparation in UC patients when not contraindicated.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Kumar A, Shenoy V, Buckley MC. et al. Endoscopic Disease Activity and Biologic Therapy Are Independent Predic-tors of Suboptimal Bowel Preparation in Patients with Inflammatory Bowel Disease Undergoing Colonoscopy. Dig Dis Sci 2022; 67 (10): 4851-4865
• 2 Manes G, Fontana P, de Nucci G. et al. Colon Cleansing for Colonoscopy in Patients with Ulcerative Colitis: Efficacy and Acceptability of a 2-L PEG Plus Bisacodyl Versus 4-L PEG. Inflamm Bowel Dis 2015; 21 (9): 2137-2144

Publication History

Article published online:
27 March 2025