Adequate bowel preparation is essential for high-quality colonoscopy, yet comparative data on preparation efficacy and tolerability in Middle Eastern populations remain limited. We compared commonly used bowel preparations in Lebanese clinical practice

This prospective, multi-center observational study enrolled 600 patients undergoing elective colonoscopy at three Lebanese hospitals over six months. Patients received polyethylene glycol 4L (Klean-prep, n=124), polyethylene glycol 2L with ascorbic acid (Moviprep, n=317), sodium picosulfate/magnesium citrate (Picoprep, n=136), or other preparations (n=23). Primary outcome was preparation quality assessed by the Boston Bowel Preparation Scale (BBPS). Secondary outcomes included patient compliance (≥80% consumption), adverse effects, and willingness to repeat the same preparation. Chi-square tests and logistic regression identified factors associated with adequate preparation (BBPS ≥6 with all segments ≥2).

Overall, 91.3% of patients achieved adequate preparation with no significant difference in mean BBPS scores between Moviprep (7.52±1.63), Picoprep (7.60±1.55), and Klean-prep (7.51±1.64, p=0.283). However, low-volume preparations demonstrated superior compliance (97.8% vs 87.9%, p<0.001) and patient acceptance. Willingness to repeat was significantly higher for Moviprep (86%) and Picoprep (74%) versus Klean-prep (25%, p<0.001). Split-dosing improved compliance (p<0.001) but did not significantly affect BBPS scores (p=0.283). Independent predictors of inadequate preparation included constipation (p<0.001), multiple comorbidities (p<0.001), and regular laxative use (p<0.001). Unexpectedly, inpatient status was associated with superior preparation quality (p<0.001).

While all preparations achieved high adequacy rates, low-volume PEG-based formulations offer superior patient tolerability and acceptance, which may enhance long-term screening adherence. Patient-specific factors including comorbidities and dietary compliance significantly impact preparation quality