336 Bowel Preparation for Patients With History of Inadequate Cleansing With 4L PEG-3350 (Golytely) Split-Prep: The 6 Liter PEG-3350 (Golytely®) Split-Prep

INTRODUCTION: No prior prospective study has assessed the efficacy of a more intensive bowel preparation (prep) for outpatients who have already failed a 4 liter (4L) PEG-3350 (GoLYTELY®) split-prep. This study assesses efficacy and safety of a 4L-2L PEG-3350 split-prep. METHODS: Inclusion Criteria - (a) colonoscopy for average-risk screening, FIT+, family history-CRC, or colon polyp surveillance; (b) history of inadequate prep with 4L GoLYTELY® or >2 risk factors for inadequate prep (daily laxative, BMI > 35, diabetes, daily tricyclic antidepressant, daily opioid). Intervention : 4L-2L PEG-3350 (GoLYTELY®) split-prep consisting of clear liquid diet (all day) and drink 4L GoLYTELY® starting at 6pm on day before procedure PLUS drink 2L of GoLYTELY® starting 5 hours before colonoscopy. Patients completed a questionnaire about demographics, adherence to prep protocol, ease of drinking prep, and adverse events. Primary Outcome : Adequate bowel prep, defined by 2-2-2 or better on Boston Bowel Preparation Scale (BBPS), among patients who failed 4L GoLYTELY® split-prep . Secondary Outcome : (a) Adequate bowel prep among patients who failed 4l GoLYTELY® pm-only prep or any lower volume prep; and, (b) patients with > 2 risk factors for inadequate prep; Tertiary Outcome : Frequency of guideline-adherent recommendations for surveillance colonoscopy among patients with adequate prep and patients with inadequate prep (i.e., repeat colonoscopy in ≤ 1 year). Data Analysis : The intention-to-treat population included all patients who underwent colonoscopy and the per-protocol population only included patients who drank ≥ 75% of prep. RESULTS: 204 consecutive patients met inclusion criteria and presented for colonoscopy. Demographic data: mean age = 65 (40-79 years); M: F = 189:15. Frequency of adequate prep in each group is presented in Table 1. Frequency of guideline-adherent recommendations was 89.6% in patients with adequate prep and was 96.6% among patients with inadequate prep. Three serious adverse events occurred: vomiting with ED visit, asymptomatic bradycardia (HR = 30-40) and spontaneous paroxysmal atrial fibrillation. Based on questionnaires, 28% stopped to pass stool during trip to endoscopy center and 80% would be willing to repeat the prep in the future. CONCLUSION: The 6L GoLYTELY® split-prep achieves adequate prep in > 85% of patients who have already failed a 4l GoLYTELY® split-prep.