A225 THE BOWEL CLEANSING NATIONAL INITIATIVE (BCLEAN): A HIGH-VOLUME SPLIT-DOSE POLYETHYLENE GLYCOL (PEG) PREPARATION VERSUS A LOW-VOLUME SPLIT-DOSE PEG SOLUTION.
Bibliographic record
Abstract
Bowel preparation is crucial in ensuring a high quality colonoscopy. Although split-dose regimens are superior with regards to bowel cleanliness, evidence still lacks amongst these as to how high-volume compares to low-volume solutions. The objective was to compare a polyethylene glycol (PEG) high-volume split-dosing (HighSD) to a PEG low-volume split-dosing (LowSD) bowel preparation. As part of one of a number trials in adult outpatients in 10 Canadian tertiary care hospitals, we prospectively randomized to split-dose PEG solutions of either high (2L+2L) or low volume (1L+1L) +Bisacodyl (15mg). Stratified randomization was carried out according to the timing of the colonoscopy (AM or PM), and a secondary randomization was completed according to diet allocation (clear fluid or low residue). The primary outcome was the Boston Bowel Preparation Scale (BBPS) in which an adequate bowel preparation was defined by a total score ≥6 with each of the 3 colonic segments subscores ≥2. Secondary objectives included patient willingness to repeat the preparation, withdrawal time, cecal intubation and polyp detection rate. Continuous and categorical variables were compared between groups using a t-test, or Chi-square test, respectively. Statistical significance is set at the p=0.05 level and analyses were intention-to-treat. Over a 29-month period, 1157 subjects were allocated to HighSD and 1157 to LowSD; 93.3% completed the trial. Mean age was 56.2 ± 13.0 years old and 52.1% were female. Reasons for colonoscopy were 38.2% non-screening, 36.8% screening and 25.0% surveillance, with no between group imbalances. A significantly greater proportion of patients in the HighSD group exhibited adequate bowel cleanliness compared to the LowSD group (90.8% vs 88.1%, p=0.041), along with greater cecal intubation rates (97.4% vs 95.6%, p=0.023). Bowel cleanliness was independent of the time of colonoscopy (AM vs PM) or diet (clear liquid vs low residue). Willingness to repeat was significantly lower in the HighSD group (66.9% vs 91.9% respectively, p<0.001). Withdrawal time was not different between groups (8.31 ± 3.23 min versus8.38 ± 3.46 min, respectively, P=0.74). The per-patient polypectomy rate was greater in the HighSD group (46.2% vs 41.8%, p=0.037). In this large randomized trial, split-dose high-volume PEG(2L+2L) improved bowel cleanliness compared to split-dose low volume PEG (1L+1L) + bisacodyl (15mg) independent of time of procedure (AM or PM) or diet (clear liquid or low residue diet), as well as cecal intubation and polypectomy rates. However, patient willingness to repeat the bowel preparation was markedly lower in the HighSD group received arm-length funding from Pendopharm Inc.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.013 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".