Hospitalized patients facing colonoscopy may soon avoid the notorious ordeal of consuming gallons of bowel preparation solution. This shift could dramatically improve patient compliance and reduce the nausea, vomiting, and electrolyte disturbances that frequently plague inpatients already weakened by illness.
Italian researchers tested three polyethylene glycol formulations across 665 hospitalized adults requiring colonoscopy: a 1-liter PEG-ascorbate solution, a 2-liter version, and the traditional 4-liter preparation. Using the standardized Boston Bowel Preparation Scale, they found adequate bowel cleansing in 82% of patients receiving the minimal 1-liter dose compared to 78% with the 2-liter and 78.5% with the 4-liter preparations—differences that were not statistically significant.
This finding challenges the longstanding assumption that more preparation volume necessarily yields better results. The equivalence is particularly meaningful for hospitalized patients, who often struggle with oral intake due to underlying conditions, medications, or procedures. Reduced fluid volume could minimize electrolyte shifts that pose risks in patients with heart failure, kidney disease, or advanced age.
However, the study's hospital setting limits broader applicability, as inpatients typically have different risk profiles and preparation challenges than outpatient populations. The research also focused on adequacy rather than optimal cleansing—only 4% achieved high-quality preparation across all groups, suggesting room for improvement regardless of volume. While this represents solid evidence for volume reduction in hospital colonoscopies, the modest cleansing rates indicate that formulation improvements may matter more than simple volume reduction for achieving truly excellent bowel preparation.