Introduction

With a growing interest in sex-specific differences in bowel preparation outcomes, current literature shows inconsistent results. Females have been associated with poor bowel preparation [1], while males may have inadequate bowel preparation due to poor compliance with instructions [2]. Analyses of randomized clinical trials of 1L polyethylene glycol (PEG) plus ascorbic acid (ASC) indicated greater high-quality (HQ) cleansing success in females than in males despite greater adenoma detection in males [3].

Aims & Methods

The effectiveness and tolerability of 1L PEG+ASC was compared in males versus females in a large real-world population. This post-hoc analysis of an observational, multi-centre, retrospective study in Spain and Portugal included patients who received 1L PEG+ASC before undergoing a colonoscopy [4]. Cleansing quality was assessed using the Boston Bowel Preparation Scale (BBPS). Adequate success was BBPS ≥6 with all segmental scores ≥2 and HQ success was BBPS ≥8 with BBPS 3 in the right colon. Polyp detection rate (PDR), adenoma detection rate (ADR) and adverse events (AEs) were also assessed. Results are reported either as mean ± SD. Chic-square test was used to compare outcomes.

Results

A total of 13,169 patients, (M/F: 6,406/6,763 aged 57.6 ± 12.7 / 56.4 ± 13.4 years) were included. The main indication for colonoscopy was (in males vs females) colorectal cancer screening: 42.5% vs 41.2%; diagnostic: 25.9% vs 32.7%; follow up: 28.6% vs 23.9%; or other: 2.9% vs 2.2%. Bowel preparations were taken either as an overnight split dose (males vs females: 32.3% vs 33.2%) or a same-day split dose (67.7% vs 66.8%). Males and females had similar (97.5% vs 97.1%) colonoscopy completion rates. Incomplete colonoscopies due to poor bowel preparation quality were rare and occurred at similar rates in males vs females (0.7% vs 0.9%).
In the overall colon, adequate success was similar in males vs females (89.5% vs 89.1%) (p = 0.40) while HQ success was more frequent in females vs males (54.1% vs 51.8%; p = 0.007). In the right colon segment, adequate success was similar in males vs females (91.4% vs 91.6%; p = 0.61), while HQ success was more frequent in females vs males (50.7% vs 47.8%; p < 0.001). The mean BBPS was similar overall and by segment (Table). As expected from the literature, the PDR and ADR were greater in males vs females in the overall colon and in the right colon (Table).

Table. Sex differences in bowel preparation parameters with 1L PEG + ASC

Variable	Males (n=6,406)	Females (n = 6,763)	P-value
Overall colon adequate success, n (%)	5,734 (89.5)	6,023 (89.1)	ns
Overall colon high-quality success, n (%)	3,317 (51.8)	3,660 (54.1)	0.007
Right colon adequate success, n (%)	5,853 (91.4)	6,196 (91.6)	ns
Right colon high-quality success, n (%)	3,063 (47.8)	3,429 (50.7)	0.0009
Overall colon total BBPS, mean ± SD Right colon BBPS, mean ± SD Transverse colon BBPS, mean ± SD Left colon BBPS, mean ± SD	7.3 ± 1.8 2.4 ± 0.7 2.5 ± 0.7 2.5 ± 0.7	7.3 ± 1.9 2.4 ± 0.7 2.5 ± 0.7 2.4 ± 0.7	ns
PDR overall colon, n (%)	3,552 (55.5)	2,926 (43.3)	<.0001
PDR right colon, n (%)	1,643 (25.7)	1,381 (20.4)	<.0001
ADR overall colon, n (%) na	2,200 (47.3) 4,654	1,753 (37.7) 4,656	<.0001
ADR right colon, n (%) na	1,139 (27.2) 4,193	915 (21.5) 4,264	<.0001

^aNumber of patients for whom histological information was available.

Males had fewer adverse events than females (1.8% vs 2.7%; p = 0.0008). While 98.2% males did not report any adverse events, those who did reported nausea (0.9%) or vomiting (0.6%). Similarly, 97.3% females did not report any adverse events, but those who did reported nausea (1.5%) or vomiting (1.0%).

Conclusion

In real-world clinical practice, 1L PEG + ASC was effective and well tolerated in both males and females. Females attained greater HQ cleansing success both overall and in the right colon.

References

References:

1. Cirocco WC et al. Dis Colon Rectum 1995; 38:964–968
2. Ness RM, et al. Am J Gastroenterol 2001; 96:1797–1802
3. Epstein M et al. Endosc Int Open 2021; 09: E1324–E1334
4. Esteban López-Jamar JM et al. UEG Journal 2022, Vol 10 (S8); OP022

Disclosure

Fatma Akriche and Carmen Turbi Disla are employees of Norgine Ltd