INCIDENCE OF SIDE EFFECTS DURING BOWEL PREPARATION PRIOR TO COLORECTAL RESECTION AND COLONOSCOPY: DO ANTIBIOTICS MATTER?
Federica S. Brecha*, Jordan Esplin, Elissa Ozanne, Lyen C. Huang, Michael J. Walker, Raminder Nirula, Jessica Cohan
Univeristy of Utah, Salt Lake City, UT
Introduction: The addition of oral antibiotics to mechanical bowel preparation (MBP+ABX) prior to colorectal resection has been shown to improve outcomes over mechanical bowel preparation alone (MBP). However, side effects may hinder successful completion of MBP+ABX. The aim of this study was to measure side effects and successful completion of bowel preparation in patients undergoing MBP+ABX compared with patients undergoing MBP alone.
Methods: This was a single-center, prospective study of consecutive adults undergoing elective colorectal resection (MBP+ABX group) or colonoscopy (MBP group). MBP+ABX consisted of 238g polyethylene glycol with neomycin 1g and flagyl 500mg at 7pm, 9pm, and 11pm. MBP consisted of 238g polyethylene glycol given in a split fashion, with the second half administered 4 hours prior to the scheduled colonoscopy. We excluded patients with inflammatory bowel disease and bowel obstruction. During bowel preparation, patients used a paper instrument to record symptoms and discomfort on an hourly basis. Discomfort was measured using a visual analog scale (range from 1-10, with 10 being the most severe). Differences between patients undergoing MBP+ABX and MBP were analyzed using chi-squared and Wilcoxon Rank Sum tests owing to non-parametric distribution. Statistical significance was set a-priori at 0.05.
Results: We enrolled 74 patients, 22 (30%) underwent MBP+ABX and 52 (70%) underwent MBP. In the MBP+ABX group there were 13 women (59%) and median age was 51 (IQR 45-61 years). In the MBP group, there were 23 women (44%) and median age was 53 (IQR 50-62 years). The indication for surgery was neoplasia (N=11, 50%), diverticulitis (N=7, 33%) and colostomy closure (N=4, 18%). The indication for colonoscopy was screening (N=27, 52%), surveillance (N=12, 23%) and diagnostic (N+13, 25%). Side effects were relatively common in both groups, although vomiting was more common in patients undergoing MBP+ABX, p<0.05 and dizziness was more common in patients undergoing MBP, p<0.05 (Figure 1). Patients undergoing MBP+ABX reported greater discomfort (median score 8, IQR 5.5-8) compared with patients undergoing MBP (median score 4, IQR 2-6), p=<0.001 (Figure 2). Only 77% of MBP+ABX patients reported completing the bowel preparation as prescribed compared with 96% of the MBP patients, p=0.01.
Limitations: This was a single center study with a relatively small number of patients in the MBP+ABX group.
Conclusions: A significant proportion of patients experience side effects during MBP+ABX and MBP. Patients undergoing MBP+ABX are more likely to experience vomiting and less likely to complete the prep as prescribed. Future work is needed to evaluate the impact of incomplete bowel preparation on clinical outcomes and to develop interventions that reduce vomiting and increase the successful completion of bowel preparation.
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