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TOPLINE:

In patients scheduled for elective colonoscopy, a single dose of prucalopride — a 5-hydroxytryptamine type 4 receptor agonist — given the evening before a 2 L split-dose polyethylene glycol (PEG) bowel preparation regimen improved the quality of bowel cleansing and was associated with higher polyp and adenoma detection rates.

METHODOLOGY:

• Colonoscopy prevents colorectal cancer, but bowel preparation failure (≤ 23%) and poor tolerance of 4 L of PEG have led to adjunctive strategies to improve colon cleansing. Prucalopride as an adjunct may improve cleansing and allow lower-volume PEG, although robust randomized trial evidence is limited.
• Researchers conducted a randomized study of 162 outpatients (mean age, 63.59 years; 55.6% men) scheduled for elective colonoscopy to determine whether adding prucalopride improves the efficacy of standard split-dose PEG for bowel preparation.
• Participants were randomly assigned to receive 2 L of split-dose PEG either with prucalopride 2 mg (n = 81; prucalopride group) or with placebo (n = 81; placebo group), with prucalopride or placebo administered orally on the evening before colonoscopy.
• The quality of bowel preparation across all colon segments (right, transverse, and left) was evaluated using the Boston Bowel Preparation Scale (BBPS; scores ranging from 0 [unprepared] to 9 [excellent]) and Ottawa Bowel Preparation Scale (OBPS; scores ranging from 0 [excellent] to 14 [completely unprepared colon]).
• The primary outcome was adequate bowel preparation, defined as a total BBPS score of 6 or higher, with all segment scores of 2 or more or an OBPS score less than 4. Secondary outcomes included adenoma detection rates, polyp detection rates, and adverse events.

TAKEAWAY:

• The prucalopride group had higher mean BBPS scores and lower mean OBPS scores across all colon segments than the placebo group, indicating significantly better bowel preparation efficacy (P < .001 for all).
• The prucalopride group had higher polyp detection rates (48.1% vs 27.2%; P = .006) and adenoma detection rates (39.5% vs 22.2%; P = .017) than the placebo group.
• Both treatment regimens were well tolerated, with no serious adverse events reported; abdominal pain was reported in 8.6% of patients in each group.

IN PRACTICE:

“[The study] results suggest that prucalopride is an effective adjunct for optimizing bowel preparation, although its direct impact on adenoma detection warrants further investigation,” the authors of the study concluded.

SOURCE:

This study was led by Anuchit Suksamai, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand. It was published online in the Journal of Gastroenterology and Hepatology.

LIMITATIONS:

This study was limited by its single-center design and the relatively small sample size. The study did not standardize or record individual withdrawal times, a known independent predictor of adenoma detection. A fixed dose and timing of prucalopride were used.

DISCLOSURES:

This study was supported by the Department of Medicine, Phramongkutklao Hospital and College of Medicine. The authors declared having no conflicts of interest. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.