Low-volume PEG-citrate-simethicone versus Standard 4L PEG for Bowel Preparation before Colonoscopy: A Prospective Real-world Study.

BACKGROUND AND AIMS: Adequate bowel preparation is essential for high-quality colonoscopy, yet no single preparation regimen has demonstrated clear superiority. Low-volume polyethylene glycol (PEG)-based solutions are increasingly used to improve patient tolerability, but real-world comparative data remain limited. We aimed to compare bowel cleansing quality and patient tolerability between a low-volume [2 liters (L)] PEG-citrate-simethicone regimen (2L-PEG-CS) and a standard 4-L PEG regimen in routine clinical practice. METHODS: This prospective, open-label, comparative study included consecutive adult patients undergoing diagnostic colonoscopy. Bowel preparation quality was assessed using the Boston bowel preparation scale (BBPS) and the Ottawa bowel preparation scale (OBPS). The primary endpoint was bowel cleansing quality; secondary outcomes included patient-reported tolerability, satisfaction, and willingness to repeat the preparation. RESULTS: A total of 124 patients were included in the analysis (47.6% received 2L-PEG-CS; 52.4% received 4-L PEG). Mean total BBPS scores were slightly higher in the 2L-PEG-CS group than in the 4-L PEG group (7.6±1.2 vs. 7.1±1.5; p=0.03). Adequate bowel preparation (BBPS ≥ 6) was achieved in 98.3% of patients receiving 2L-PEG-CS and 84.6% receiving 4-L PEG (p=0.01), while rates of high-quality preparation were similar between groups. Total OBPS scores did not differ significantly between regimens (4.2±3.2 vs. 5.0±3, p=0.14). Foam scores were lower in the 2L-PEG-CS group (p<0.001). Patients receiving 2L-PEG-CS reported higher satisfaction, better taste, greater completion of the prescribed preparation, and a higher willingness to repeat the same regimen if needed. CONCLUSIONS: Low-volume PEG-citrate-simethicone showed bowel cleansing quality comparable to standard 4-L PEG, with more favorable patient-reported tolerability. These findings suggest that it may be a reasonable alternative in routine clinical practice.