S761 Augmented Miralax Bowel Preparation for Colonoscopy: an Assessment of Quality of Bowel Preparation

Introduction: Inadequate bowel preparation is associated with lower rates of adenoma detection and cecal intubation, 2 well established quality markers of colonoscopy as the gold standard for colorectal cancer (CRC) screening and prevention. There is a plethora of bowel preparation strategies available to patients, and many comparisons between different formulations have been described previously. In this study, we discuss an augmented Miralax bowel preparation schedule and compare it to other bowel preparations. Methods: Cases were identified retrospectively using procedural data for procedures at a quaternary academic hospital performed between January 2019 and February 2022, during which time the default colonoscopy bowel preparation was changed twice due to limited availability of different formulations during the COVID-19 pandemic. These included preparations with Golytely, a standard Miralax dose (238g split in 2 doses), and an augmented Miralax dose (306g split in 2 doses). Bowel preparation assessment scores determined by the endoscopist were converted to a categorical scale with 5 categories (unknown, poor, fair, good, and excellent). Chi-square analysis was used to analyze the difference in quality of preparation between the three different bowel preparation strategies. Results: Over the study period, there were 43933 total colonoscopies performed. Golytely was the default preparation used during 23636 of these colonoscopies, standard Miralax was the default for 10082 colonoscopies, and augmented Miralax was the default for 10215 colonoscopies. The quality of bowel preparation was unknown in 2.3% of all cases without significant difference between the 3 (P=0.48). The majority of bowel preparations were either good (48.8%) or excellent (41.3%). The percentage of bowel preparations that were good or excellent for the Golytely, standard Miralax, and augmented Miralax preparations were 90.3%, 88.9%, and 90.9%, respectively, which were not significantly different (P=0.29). The percentage of excellent preparations for each group were 38.1%, 42.2%, and 47.9%, which was statistically significant (P< 0.001) (Figure 1). Conclusion: An augmented Miralax bowel preparation strategy resulted in more excellent bowel preparations than either Golytely or standard Miralax bowel preparations. The benefits of this strategy include greater accessibility and lower cost than other prescription preparations. The augmented Miralax strategy is an effective method that can be considered for colonoscopy bowel preparation.Figure 1.: Quality of bowel preparation for colonoscopies using Golytely, standard Miralax, and augmented Miralax strategies, with percentages displayed. The number of good or excellent bowel preparations remained unchanged between each preparation strategy (P=0.29), but the percentage of excellent bowel preparations increased from 38.1% in the Golytely group to 42.2% in the standard Miralax group and 47.9% in the augmented Miralax group (P<0.001).