Objective:

To compare the effectiveness of 1-L polyethylene glycol-ascorbate bowel preparation against 2-L and 4-L PEG-ascorbate specifically in hospitalized adults undergoing elective colonoscopy.

Key Findings:

• Adequate cleansing rates were similar across groups: 82% (1 L), 78% (2 L), 79% (4 L).
• High-quality cleansing occurred more often with 1-L regimen (47%) compared to 2-L (35%) and 4-L (37%).
• Willingness to repeat preparation was highest in the 1-L group (84%).
• Vomiting was more frequent with the 1-L regimen (15%) compared to 2-L (7%) and 4-L (11%).
• Polyp detection rates were 31% (1 L and 4 L) and 23% (2 L).

Interpretation:

The 1-L PEG-ascorbate preparation resulted in higher quality bowel cleansing without compromising adequate cleansing rates, suggesting it may be a preferable option for hospitalized patients.

Limitations:

• The study was underpowered due to not reaching the planned enrollment of 846 patients, which limits the reliability of the primary endpoint findings.
• Findings for the primary endpoint should be interpreted cautiously due to the study's design limitations.
• The trial excluded patients undergoing urgent colonoscopy or with severe conditions, which may limit the generalizability of the results to broader populations.

Conclusion:

In hospitalized adults undergoing elective colonoscopy, 1-L PEG-ascorbate yielded higher rates of high-quality cleansing with similar adequate cleansing rates and high willingness to repeat, though these findings should be interpreted in light of the study's limitations.