Comparison of efficacy of low-volume bowel cleansers prior to colonoscopy: a randomised, prospective, open-label trial

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Authors: V. Kojecký ¹; J. Matouš ²; Bohuslav Kianička ³ ; Z. Zádorová ²; M. Varga ¹
Authors place of work: Interní oddělení, Krajská nemocnice T. Bati, Zlín ¹; II. interní klinika Fakultní nemocnice Královské Vinohrady a III. lékařská fakulta Univerzity Karlovy, Praha ²; II. interní klinika Fakultní nemocnice u sv. Anny v Brně ³
Published in the journal: Rozhl. Chir., 2019, roč. 98, č. 7, s. 277-281.
Category: Original articles

Summary

Introduction: The aim of the study was to compare the efficacy and tolerability of polyethylene glycol/ascorbic acid (PEGA), sodium picosulfate/magnesium citrate (SPMC) and the oral sulfate formula (SIR) in a single- or split-dose regimen for bowel preparation prior to colonoscopy.

Methods: Randomised, multicentre, open-label study. The subjects received either PEGA, SPMC or SIR in the single- or split-dose regimen before the colonoscopy. Quality and tolerability of the preparation and complaints during preparation were recorded using a 5 point scale.

Results: 558 subject were analysed. Preparation quality was comparable in the single-dose regimen. The rate of satisfactory bowel cleansing (Aronchick score 1+2) was higher for split-dose SIR and PEGA compared to SPMC (95.6%, 86.2% vs. 72.5%, p<0.028). The highest tolerance rate (score 1+2) was reported for SPMC (82.3%, p0.003) and the lowest for single-dose SIR (34.8%, p=0.008). The lowest frequency of nausea (10.4%) was observed for SPMC. The highest prevalence of bloating was linked with the use of PEGA (34.0%).

Conclusion: Differences in bowel preparation quality were apparent only in the split-dose regimen, with SIR rated as most efficient. SPMC was the best tolerated formula. The split-dose regimen is more effective than single-dose preparation used in the evening before the examination.

Keywords:

ascorbic acid – colonoscopy – picosulfate – polyethylene glycol – sulfates

Zdroje

Falt P, Urban O, Suchánek Š, et al. Czech Society of Gastroenterology guidelines for diagnostic and therapeutic colonoscopy. Gastroent Hepatol. 2016;70:523–38. doi: 10.14735/amgh2016csgh.info19.
Liu Z, Li YY, Luo XT, et al. Split-dose 4-L polyethylene glycol regimen for patients with previous colorectal surgery in bowel preparation before colonoscopy: A randomized, controlled, single-blind study. J Dig Dis. 2018;19:359–68. doi: 10.1111/1751-2980.12608.
Leitao K, Grimstad T, Bretthauer M, et al. Polyethylene glycol vs sodium picosulfate/magnesium citrate for colonoscopy preparation. Endosc Int Open. 2014;2:E230−34. doi: 10.1055/s-0034-1377520.
Voiosu T, Ratiu I, Voiosu A, et al. Time for individualized colonoscopy bowel-prep regimens? A randomized controlled trial comparing sodium picosulphate and magnesium citrate versus 4-liter split-dose polyethylene glycol. J Gastrointestin Liver Dis. 2013;22:129–34.
Sahebally SM, Burke JP, Chu S, et al. A randomized controlled trial comparing polyethylene glycol + ascorbic acid with sodium picosulphate + magnesium citrate solution for bowel cleansing prior to colonoscopy. Ir J Med Sci. 2015;184:819–23. doi: 10.1007/s11845-014-1182-4.
Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc. 2004;59:482–6.
Worthington J, Thyssen M, Chapman G, et al. A randomised controlled trial of a new 2 litre polyethylene glycol solution versus sodium picosulphate + magnesium citrate solution for bowel cleansing prior to colonoscopy. Curr Med Res Opin. 2008;24:481−8. doi: 10.1185/030079908X260844.
Choi HS, Chung JW, Lee JW, et al. Polyethylene glycol plus ascorbic acid is as effective as sodium picosulfate with magnesium citrate for bowel preparation: A randomized trial: PEG + Asc versus SPMC. J Dig Dis. 2016;17:268–73. doi: 10.1111/1751-2980.12337.
Sharara AI, Daroub H, Georges C, et al. Sensory characterization of bowel cleansing solutions. World J Gastrointest Endosc. 2016;8:508–16. doi: 10.4253/wjge.v8.i15.508.
Choi HS, Shim CS, Kim GW, et al. Orange juice intake reduces patient discomfort and is effective for bowel cleansing with polyethylene glycol during bowel preparation. Dis Colon Rectum. 2014;57:1220–7. doi: 10.1097/DCR.0000000000000195.
Di Palma JA, Rodriguez R, McGowan J, et al. A randomized clinical study evaluating the safety and efficacy of a new, reduced-volume, oral sulfate colon-cleansing preparation for colonoscopy. Am J Gastroenterol. 2009;104:2275–84. doi: 10.1038/ajg.2009.389.
Rex DK, McGowan J, Cleveland M, et al. A randomized, controlled trial of oral sulfate solution plus polyethylene glycol as a bowel preparation for colonoscopy. Gastrointest Endosc. 2014;80:482–91. doi: 10.1016/j.gie.2014.03.043.
Manes G, Amato A, Arena M, et al. Efficacy and acceptability of sodium picosulphate/magnesium citrate vs low-volume polyethylene glycol plus ascorbic acid for colon cleansing: a randomized controlled trial. Colorectal Dis. 2013;15:1145–53. doi: 10.1111/codi.12246.
Hoy SM, Scott LJ, Wagstaff AJ. Sodium picosulfate/magnesium citrate: A review of its use as a colorectal cleanser. Drugs 2009;69:123–36. doi: 10.2165/00003495-200969010-00009.