Comparative analysis of different doses of polyethylene glycol electrolyte solution for colonoscopy preparation
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Abstract:
Objective
To compare the efficacy of bowel-cleansing, patients′ compliance, tolerability and side effects of different doses of polyethylene glycol(PEG) electrolyte solution for colonoscopy preparation.
Methods
Single-blind prospective randomized trial was performed. A total of 100 inpatients undergoing elective colonoscopy were randomized into three groups to receive 4 L PEG(n=35), 2 L PEG(n=31) or 2+ 1 L PEG(n=34), respectively, on the day of colonoscopy from May to July 2014. Bowel-cleansing efficacy was separately assessed with the Ottawa Scale for the right, middle, and left colon. Total score was obtained by adding the scores for individual evaluation of the three colon segments with the score of overall fluid in the entire colon. All patients filled in a questionnaire and were interviewed about their compliance to the assigned bowel preparation, tolerability, and side effects.
Results
Patients who did not complete the colonoscopy were excluded. A total of 91 patients were included in the last analysis: 31 cases of 4 L group, 30 cases of 2 L group and 30 cases of 2+ 1 L group. The efficacy of bowel-cleansing of the three groups of patients according to the Ottawa Scale were similar(P>0.05), but the excellent and good rate of cleansing quality of the right colon was higher in 4 L group than in 2 L group(P<0.05). Compared with 4 L group and 2+ 1 L group, patients in the 2 L group had higher compliance and tolerability, as well as lower rate of side effects(P<0.05).
Conclusion
The efficacy and safety of taking 2 L polyethylene glycol electrolyte solution in bowel-cleansing on the day of colonoscopy is good and suitable for use. Taking 4 L polyethylene glycol electrolyte solution for bowel preparation on the day of colonoscopy is more suitable for patients who are suspected highly with lesions of the right colon.
Key words:
Polyethylene glycols; Electrolytes; Colonoscopy; Bowel preparationKeywords:
Tolerability
Bowel preparation
As a bowel cleansing agent for colonoscopy, sodium phosphate (NaP) has been reported to have equal effectiveness and better patient tolerance in comparison with 4 l polyethylene glycol-electrolyte lavage (PEG-EL) solution. Poor patient tolerance is frequently associated with a large amount of fluid consumed, and better patient tolerance might therefore be expected if the volume of PEG-EL solution could be reduced. This study aimed to compare 2 l PEG-EL solution with NaP in relation to patients' tolerance and its effectiveness as a bowel cleansing agent.Two hundred consecutive patients admitted to the day-procedure ward for elective colonoscopy were prospectively randomized to receive either a 2-l PEG-EL solution or a 90-ml oral NaP regimen. Patients with a history of congestive heart failure, impaired renal function (creatinine > 1.5 mg/dl), or previous colectomy were excluded from the study. The patients completed a questionnaire to assess their tolerance of bowel preparation before the colonoscopy. Endoscopists, who were blinded to the type of regimen that had been used, scored the adequacy of bowel preparation from the rectum to cecum using a defined endoscopic score.Two hundred patients were included in this randomized trial. Nine patients were excluded, due to either an incomplete questionnaire (two in the PEG-EL group, one in the NaP group) or inability to complete the bowel preparation regimen (four in the PEG-EL group and two in the NaP group). The demographic data were comparable in the two groups. There were no differences between the two groups with regard to willingness to repeat the regimen, ease of consumption, acceptability of the bowel preparation regimen, or the endoscopists' satisfaction with the quality of bowel preparation. The NaP group had a better mean endoscopic score at the cecum compared with the PEG-EL group (1.47 +/- 1.15 vs. 1.05 +/- 0.76; P = 0.007).The effectiveness and patient tolerance of the 2-l PEG-EL solution is comparable with that of oral NaP. The 2-l PEG-EL solution is therefore an effective alternative as a bowel-cleansing agent for colonoscopy.
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The ideal bowel cleansing regimen for colonoscopy has yet to be determined.To compare the cleansing efficacy, and patient tolerability and safety of four bowel preparation regimens.A total of 834 patients undergoing outpatient colonoscopy were randomly assigned to one of four regimens: 4 L polyethylene glycol (PEG); 2 L PEG + 20 mg bisacodyl; 90 mL of sodium phosphate (NaP); or two sachets of a commercially available bowel cleansing solution (PSMC) + 300 mL of magnesium citrate (M). The primary outcome measure was cleansing efficacy, which was scored by blinded endoscopists using the Ottawa Bowel Preparation Scale. Secondary outcome measures were bowel preparation quality according to time of colonoscopy, and patient tolerability and safety.The mean total cleansing score was significantly worse in the NaP group compared with the other three groups (P<0.0001). The mean cleansing scores were worse in patients who underwent morning versus afternoon colonoscopy, a finding that was consistent in all four groups. PSMC + M was the best tolerated regimen. No clinically significant mean changes in creatinine or electrolyte levels were identified, although a significantly higher proportion of patients in the NaP group developed hypokelemia (P<0.0001).2 L PEG + 20 mg bisacodyl, or PSMC + M was as efficacious as 4 L PEG and superior to NaP for bowel cleansing. A short interval between the completion of bowel preparation and the start of colonoscopy (ie, 'runway time'), irrespective of bowel preparation regimen, appeared to be a more important predictor of bowel cleanliness than the cathartic agents used.
Tolerability
Regimen
Bisacodyl
Intention-to-treat analysis
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Background: There are many preparation regimens for bowel cleansing. Given their adverse effects, none of them have been considered perfect by the endoscopists. The aim of this study was to compare the effects of two bowel cleansing regimens on clean colonic preparation the subjects'well being and electrolyte balance. Materials andMethods: Atotal number of 280 patients were randomly assigned to receive either magnesium sulfate (group A, N = 140) or polyethylene glycol (group B, N = 140) as a bowel preparation regimen for colonoscopy. Patients in group A received 120 ml magnesium sulfate 33%. Patients in group B received 2 liter Polyethylene Glycol one day before and 2 liter Polyethylene Glycol on the day of procedure. The quality of preparation was graded by an endoscopist who was blinded to the type of preparation. The simplicity of preparation method, taste of the preparation and their adverse effects were also recorded by an independentblinded investigator, using a questionnaire before the colonoscopy. Blood samples were taken from subjects before and after colonoscopy. Results: The quality of bowel cleansing was significantly higher in group A (P=0.039). There was no significant difference between the two regimens regarding their side effects and the simplicity of preparation method. However, preparation taste was reported significantly worse in group A (p ‹0.001). Blood samples showed that creatinine and urea decreased more in groupAand potassium decreased more in group B, but all were within the normal limits. Conclusion: Considering our results magnesium sulfate with regard to price and availability is recommended for bowel preparation. Â
Bowel preparation
Regimen
Cathartic
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Objective
To investigate the clinical effects of different bowel preparation methods before colonoscopy in elderly patients.
Methods
A total of 84 elderly patients undergoing colonoscopy during July 2015 and July 2016 were divided into two groups (n=42 for each group) . Repeat group was treated with 1 L Polyethylene Glycol (PEG) orally for bowel preparation at night before the colonoscopy and 2 L PEG on the day of colonoscopy respectively. Single group was treated with 3 L PEG for bowel preparation on the day of colonoscopy. In the two groups, bowel preparation efficacy, patient′s compliance, tolerability and adverse reactions were evaluated.
Results
According to the Boston bowel preparation scale (BBPS) , the score of total colon cleaning effect was (7.49±1.33) in repeat group and (5.29±1.45) in single group with a significant difference (t=2.78, P 0.05) .
Conclusions
It is the proper method for elderly patients who are treated with PEG orally and repeatedly before colonoscopy.
Key words:
Aged; Bowel preparation; Repeat oral method; Signal oral method
Bowel preparation
Tolerability
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Background: Nowadays colonoscopy has a very important role in screening colorectal cancers. In addition, adequate bowel preparation is critical to colonoscopy, as a poor preparation may obscure pathology or prevent full colonoscopy. As it is estimated that unsuccessful colonoscopy leads to second procedures in up to 20% of patients, we sought to compare the effects of different doses of polyethylene glycol (PEG) versus castor oil based lavage preparation for colonoscopy. Materials and Methods: In this double blind, randomized clinical trial 117 patients who were supposed to undergo colonoscopy, were allocated randomly into 4 groups in order to receive different lavage preparation protocols: 29 patients under 2 sachets of PEG (group A), 30 patients under 3 sachets of PEG (group B), 32 patients under 4 sachets of PEG (group C) and 26 patients under castor oil (group D). All the used PEG were Macrogol 4000 produced by Sepidaj pharmacy. The quality of bowel preparation was assessed using a scale of 1 to 8 and the higher the grade was, the poorer the bowel was prepared. Results: The highest and lowest mean grade of colonoscopy preparation were seen in groups A (2.79, SEM=0.36)-the worst preparation-and D (2.46, SEM=0.35)-the best preparation-respectively. However, the difference was not statically significant (p=0.224).The highest and lowest number of patients who were needed to repeat colonoscopy because of poor preparation were also seen in groups A (24.1%) and D (7.7%), respectively. Conclusion: It seems that usage of PEG may accompany with less gastrointestinal complications such as nausea and vomiting, compared with castor oil; although, no significant difference in quality of bowel preparation was seen in our study.
Bowel preparation
Cathartic
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Background and study aims: The high volume and poor palatability of 4 L of polyethylene glycol (PEG)-based bowel cleansing preparation required before a colonoscopy represent a major obstacle for patients. The aim of this study was to compare two low volume PEG-based preparations with standard 4 L PEG in individuals with a positive fecal immunochemical test (FIT) within organized screening programs in Italy. Patients and methods: A total of 3660 patients with a positive FIT result were randomized to receive, in a split-dose regimen, 4 L PEG or 2 L PEG plus ascorbate (PEG-A) or 2 L PEG with citrate and simethicone plus bisacodyl (PEG-CS). The noninferiority of the low volume preparations vs. 4 L PEG was tested through the difference in proportions of adequate cleansing. Results: A total of 2802 patients were included in the study. Adequate bowel cleansing was achieved in 868 of 926 cases (93.7 %) in the 4 L PEG group, in 872 out of 911 cases in the PEG-A group (95.7 %, difference in proportions + 1.9 %, 95 % confidence interval [CI] – 0.1 to 3.9), and in 862 out of 921 cases in the PEG-CS group (93.6 %, difference in proportions – 0.2 %, 95 %CI – 2.4 to 2.0). Bowel cleansing was adequate in 95.5 % of cases when the preparation-to-colonoscopy interval was between 120 and 239 minutes, whereas it dropped to 83.3 % with longer intervals. Better cleansing was observed in patients with regular bowel movements (95.6 %) compared with those with diarrhea (92.4 %) or constipation (90.8 %). Conclusion: Low volume PEG-based preparations administered in a split-dose regimen guarantee noninferior bowel cleansing compared with 4 L PEG. Constipated patients require a personalized preparation. Trial registration: EudraCT 2012 – 003958 – 82.
Bisacodyl
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Cathartic
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OBJECTIVE To evaluate the impact of a new same‐day, low‐dose 1‐L polyethylene glycol‐based (1‐L PEG) bowel preparation on the diagnostic rating of selected hospitalized patients and its tolerability, with risk factors for inadequate bowel preparation. METHODS A single‐center prospective pilot study was conducted with hospitalized patients scheduled for colonoscopy, presenting risk factors for poor bowel preparation, such as bleeding or subocclusive symptoms. The included patients were randomly divided in two groups, which received either a same‐day 1‐L PEG (group A) or a split‐dose 4‐L PEG (group B), and performed a colonoscopy within 4 h of the last dose. RESULTS In all, 44 inpatients [27 males; mean age 63.5 years (range 20–94 years)] were enrolled. Optimal bowel cleansing was reached in 64% and 55% ( P = 0.64) of patients in groups A and B, respectively. The adenoma detection rate was 14% (group A) and 18% (group B) ( P = 0.34). A valid diagnosis was reached in 38 (86%) of 44 patients (21 in group A and 17 in group B) after a mean hospitalization of 3 days for group A and 6 days for group B ( P = 0.04). CONCLUSIONS Our data support the conclusion that the schedule protocol proposed in this study enables a clear diagnosis in most of the inpatients at high risk of poor bowel preparation and no statistical differences were found between the two groups in terms of successful bowel cleansing achieved. Therefore, the same‐day, low‐dose 1‐L PEG bowel preparation could be introduced for selected inpatients.
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Objective
To investigate the safety and effectiveness of Glifeet in bowel preparation before colonoscopy.
Methods
A prospective, single blind, randomized controlled trial of patients undergoing colonoscopy was conducted. A total of 67 inpatients were randomized to the control group, who received a low-residue and semiliquid diet (n=31) and the experimental group, who received Glifeet all day (n=36) before the procedure. All patients took polyethylene glycol electrolyte powder 1 000 ml at 7 pm on the day before colonoscopy and 2 000 ml at 8 am on the examination day. Bowel preparation quality was scored using the Boston Bowel Preparation Scale (BBPS). Side effects were also observed.
Results
The time of the first bowel movement of the experimental group was significantly shorter [(77.43±54.21) min VS (149.35±118.15) min, P=0.002]. An increased defecating frequency was observed in the experimental group, but there was no significant difference when compared with the control group (11.44±6.95 VS 8.74±3.58, P=0.055). Patient tolerance and acceptance did not differ. There was no significant difference in BBPS between the two groups. But the bowel preparation quality of the right colon was significantly better in the experimental group (2.56±0.50 VS 2.23±0.81, P=0.045).
Conclusion
Glifeet could meet the needs of basic energy in most patients for colonoscopy. Furthermore, Glifeet is well tolerated and can partially improve the quality of bowel preparation.
Key words:
Colonoscopy; Bowel preparation; Diet; Polyethylene glycols
Bowel preparation
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Background and Aim To compare the efficacy and tolerability of a low‐volume (2‐ L ) polyethylene glycol ( PEG ) regimen for colonoscopy compared to single (4‐ L ) or split‐dose (2‐ L + 2‐ L ) regimens. Methods In‐hospital patients who were candidates for colonoscopy were randomly assigned to: group 1 single‐dose ( PEG 4 L the day before the study, n = 60); group 2: split‐dose (2 L the day before and 2 L on the day of the procedure, n = 61); and group 3: low‐volume 2‐ L PEG solution (the day of the procedure, n = 59). A blinded evaluation of the quality of colonic preparation was assessed by the B oston bowel preparation scale. Results Satisfactory bowel preparation of the right colon was more frequently reported for group 3 than for group 1 (70% vs 53%, P = 0.045), in the transverse colon it was 82% versus 69% ( P = 0.032), and on the left side of the colon it was 80% versus 67.7% ( P = 0.028). Compared to group 2, satisfactory bowel preparation in group 3 was similar in the transverse colon and left colon. Nausea, vomiting, and abdominal discomfort were less frequent in patients of group 3. Patients in group 3 had fewer sleep disorders and fewer hours of sleep loss compared to patients in the other groups. Conclusions Preparation with 2 L caused less abdominal discomfort and fewer sleep disorders. The split dose had a better quality of preparation in the right colon. Both preparations were clearly better than the 4‐ L preparation.
Tolerability
Bowel preparation
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Cathartic
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