Aim : Colonoscopy is the gold standard for colorectal cancer screening and prevention. This multicenter study aims to evaluate and compare the effectiveness, cost-efficiency, and patient tolerability of different bowel preparation regimens for colonoscopy using a high-volume polyethylene glycol-based solution. Materials and methods : A total number of 746 patients were enrolled from three Bulgarian centers and were randomly assigned to various bowel preparation protocols categorized as previous-day, split-day, and same-day regimens. Effectiveness was assessed using the Boston Bowel Preparation Scale, cost-efficiency was determined by healthcare facility expenses, and patient tolerability was evaluated through patient-reported questionnaires. Results : The split-dose regimens achieved the highest bowel cleansing quality, significantly outperforming the other two groups. Furthermore, SPLIT4, one of the split-dose regimens, achieved the highest median Boston Bowel Preparation Scale (BBPS) score of 8, significantly outperforming previous-day and other split-dose protocols ( p <0.001), while maintaining excellent patient tolerability (mean score 1.25). Conclusion : Split-dose preparation using a high-volume polyethylene glycol solution demonstrated superior bowel cleansing and favorable patient tolerability, supporting current clinical guidelines. Future research should further investigate comparisons between high-volume and low-volume polyethylene glycol solutions to optimize patient adherence and outcomes.

Background and Objectives: Pancreatic pseudocysts often arise as complications of pancreatitis and present unique challenges in clinical management, encompassing considerations for both technical aspects and financial implications. Before the advancements of invasive gastroenterology, pancreatic pseudocysts have been drained surgically for many years. Nowadays, we have less invasive techniques with higher efficiency and lower mortality rates, however, they remain cost-challenging for most countries. Materials and Methods: We present four patients (two males and two females) with pancreatic pseudocysts who underwent endoscopic ultrasound-guided transgastric drainage using plastic stents accompanied by a standard lavage protocol using a nasocystic catheter. Results: All four patients had successful outcomes, and a follow-up at 6 months revealed no traces of the pseudocysts or any significant long-term complications. One acute complication (arterial bleeding) and one late complication (stent migration) were observed. As the study aimed to present a cheaper option for draining pancreatic pseudocysts, we investigated and compared costs for the materials we utilized and those associated with lumen-apposing metal stents. Upon compiling the data, a notable advantage was evident in favour of our method. Conclusions: While EUS-guided drainage of pancreatic pseudocysts using lumen-apposing metal stents (LAMSs) represents a high-end strategy for treating pancreatic pseudocysts, our method demonstrates better cost-effectiveness without compromising efficacy.