Colorectal Cancer, Colonic Polyp
Conditions
Keywords
colonoscopy, bowel preparation, Quality of life, Costeffectiveness
Brief summary
Adequate bowel preparation for colonoscopy is paramount for optimal diagnostic accuracy and safety. However, the need for high volumes to clean the colon often makes it difficult for patients to adhere to. Therefore, new low volume bowel preparation fluids have been developed. Little is known on the impact of these low volume bowel preparation fluids (1L), compared to intermediate-volume (2L) laxatives on quality of life (QoL) and cost-effectiveness. This study aims to provide further evidence on the presumed positive effect of ultra-low volume bowel preparation on patients' QoL and cost-effectiveness, in addition to its already demonstrated positive effect on bowel cleansing for colonoscopy. This multicenter randomized controlled trial (RCT) will be conducted in four hospitals in the Netherlands. Secure web-based questionnaires will be used before starting bowel preparation (baseline, t=0) and within 1 week (t=1) after colonoscopy, to assess the impact of bowel preparation on QoL and explore costs and productivity loss for cost-effectiveness analysis.
Detailed description
Background and aims: Adequate bowel preparation for colonoscopy is paramount for optimal diagnostic accuracy and safety. However, the need for high volumes to clean the colon often makes it difficult for patients to adhere to. Therefore, new low volume bowel preparation fluids have been developed. Little is known on the impact of these low volume bowel preparation fluids (1L), compared to intermediate-volume (2L) laxatives on quality of life (QoL) and cost-effectiveness. This study aims to provide further evidence on the presumed positive effect of ultra-low volume bowel preparation on patients' QoL and cost-effectiveness, in addition to its already demonstrated positive effect on bowel cleansing for colonoscopy. Study design: This multicenter randomized controlled trial (RCT) will be conducted in four hospitals in the Netherlands. Secure web-based questionnaires will be used before starting bowel preparation (baseline, t=0) and within 1 week (t=1) after colonoscopy, to assess the impact of bowel preparation on QoL and explore costs and productivity loss for cost-effectiveness analysis. Data on colonoscopy findings and complications will be retrieved from the patients' medical record. Study population: This multicenter study will include 470 patients from 4 hospitals. Intervention: Patients will be randomized during the pre-colonoscopy hospital visit between a specialized low-volume 1-liter bowel preparation fluid (Pleinvue) or an intermediate-volume 2-liter bowel preparation fluid (Moviprep), which are already both routinely used as bowel preparation for colonoscopy in the Netherlands. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: There is no direct benefit for patients participating in this study. Risk associated with participation are considered minimal, and are limited to the possibility of privacy related issues. Nonetheless, this is considered to be minimal because of the use of pseudonymized data and GDPR compliant databases. In the future, results from this study could possibly benefit patients undergoing colonoscopy, with the possibility of reducing the need for repeat colonoscopies and improving patient experience of colonoscopies.
Interventions
DRUGPlenvu
a recently developed 1 liter bowel preparation fluid that is often used in clinical practice. Patients will receive a split dose protocol, low-residue diet 2 days before colonoscopy, and clear liquid diet 1 day before colonoscopy.
DRUGMoviprep
a 2 liter widely established 2 liter bowel preparation fluid that is commonly used in clinical practice. Patients will receive a split dose protocol, low-residue diet 2 days before colonoscopy, and clear liquid diet 1 day before colonoscopy.
Sponsors
Radboud University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Patients will be randomized during the pre-colonoscopy hospital visit between a specialized low-volume 1-liter bowel preparation fluid (Pleinvue) or an intermediate-volume 2-liter bowel preparation fluid (Moviprep)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years * Planned elective colonoscopy for surveillance or diagnostic indications
Exclusion criteria
* Therapeutic colonoscopy (e.g. endoscopic mucosal resection (EMR) * History of (sub) total colectomy * Inflammatory bowel disease (IBD) * Inpatient status * Indication for an intensified bowel preparation regime * Emergency colonoscopy * Limited Dutch language skills * Dementia * Visual impairment * Commonly accepted contra-indications for non-iso osmotic bowel preparation and ascorbate: * Glucose-6-phosphate-dehydrogenase (G6PD) deficiency * (sub)ileus * Bowel obstruction or perforation * Acute abdomen * Gastroparesis * intolerance for any of the formulation ingredients * Severe renal insufficiency (creatinine clearance \< 30mL/min) * Congestive heart failure (NYHA III or IV) * Phenylketonuria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Boston Bowel preparation scale score (total and per segment) | during colonoscopy procedure | Level of bowel cleanliness achieved with the bowel preparation used. Segmental scores range from 0 to 3, in which 0 is worst and 3 is best. A segmental score of 2 or more is considered adequate for colonoscopy. |
| Proportion of adequately prepared patients per type of bowel preparation | during colonoscopy procedure | Level of bowel cleanliness achieved with the bowel preparation used. Segmental boston bowel preparation scores range from 0 to 3, in which 0 is worst and 3 is best. A segmental score of 2 or more is considered adequate for colonoscopy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlation of clinical parameters and tolerability to Quality of life scores | questionnaire 2/2, within 1 week after colonoscopy | Correlation of answers to questionaire on tolerability and relation to bowel cleanliness to scoring on SF-36 (short form 36) and EQ-5D-5L (EuroQol group 5 dimensions 5 levels), higher scores indicate a higher quality of life. |
| Subgroup differences for absolute scores on SF-36 for colonoscopy indication and prior experience with bowel preparation | questionnaire 2/2, within 1 week after colonoscopy | Change in QoL scores on SF-36 based on having prior experience with bowel preparation, and differences between colonoscopy indications. SF-36 (short form 36), higher scores indicate a higher quality of life. |
| Subgroup differences in costs for colonoscopy indication and prior experience with bowel preparation | questionnaire 2/2, within 1 week after colonoscopy | Change in costs based on having prior experience with bowel preparation, and differences between colonoscopy indications. |
| absolute score of SF-36 (short-form 36) | within 1 week after colonoscopy, questionnaire 2/2 | Change in scoring on the short-form 36 questionnaire before and after bowel preparation. Higher scores indicate a higher quality of life. |
| Total individual costs | questionnaire 2/2, within 1 week after colonoscopy | Total costs made per individual for the bowel preparation process, including cost for being absent at work and caregiver costs. |
| Incremental cost-effectiveness ratio | within 1 week after colonoscopy, questionnaire 2/2 | Change in costs per quality adjusted life years between the low-volume arm and intermediate volume arm. |
| treating physician advised surveillance interval per study arm | During colonoscopy procedure | advised surveillance interval correlated to colonoscopy findings and BBPS (boston bowel preparation scale) score by the treating physician. Higher scores indicate higher bowel cleanliness |
| Subgroup differences for absolute scores on EQ-5D-5L for colonoscopy indication and prior experience with bowel preparation | questionnaire 2/2, within 1 week after colonoscopy | Change QoL scores on EQ-5D-5L based on having prior experience with bowel preparation, and differences between colonoscopy indications. EQ-5D-5L (EuroQol group 5 dimensions 5 levels), higher scores indicate a higher quality of life. |
| absolute score EQ-5D-5L | within 1 week after colonoscopy, questionnaire 2/2 | Change in scoring on EuroQol group 5Dimension-5Levels questionnaire before and after bowel preparation. Higher scores indicate a higher quality of life. |
Countries
Netherlands
Outcome results
None listed