Comparable Efficacy of Prucalopride and 2‐L Polyethylene Glycol Versus 2‐L Polyethylene Glycol for Bowel Preparation in Colonoscopy: A Randomized, Double‐Blind, Placebo‐Controlled Trial

BACKGROUND AND AIMS: Prior studies have demonstrated that prokinetic agents improve the efficacy of bowel cleansing before colonoscopy. This study aimed to investigate the potential benefits of prucalopride in enhancing the efficacy and tolerability of bowel preparation for colonoscopy. METHODS: This is a prospective, single-center, randomized, double-blind, placebo-controlled trial. We compared the efficacy and safety of a 2-L split-dose polyethylene glycol (PEG) bowel preparation regimen combined with prucalopride to a standard 2-L split-dose PEG regimen in 162 patients undergoing colonoscopy. Primary outcomes included bowel cleansing efficacy, assessed by blinded endoscopists using the Boston Bowel Preparation Scale (BBPS) and Ottawa Bowel Preparation Scale (OBPS). Secondary outcomes included adenoma detection rates (ADRs), adverse events, and tolerability of the bowel preparation regimens. RESULTS: All patients successfully underwent colonoscopy with complete cecal intubation. The 2-L PEG plus prucalopride group demonstrated significantly higher bowel preparation quality than did the control group, as assessed via the BBPS and OBPS. Significant improvements were observed in the prucalopride group across all colonic segments (right, transverse, and left) for both scales. The 2-L PEG plus prucalopride group demonstrated significantly higher polyp detection rates (PDRs) (48.1% vs. 27.2%, p = 0.006) and ADRs (39.5% vs. 22.2%, p = 0.017) than did the placebo group. Both treatments were safe and without serious adverse events. CONCLUSIONS: Prucalopride is an effective and safe adjunct to 2-L PEG, significantly enhancing bowel cleansing quality. The observed increases in PDR and ADR suggest a potential for improved diagnostic yield, although further research is needed to confirm a causal relationship. TRIAL REGISTRATION: Website and Number: https://www.thaiclinicaltrials.org; identifier: TCTR20250121003.