Importance of the field-In developed countries colonoscopy volume has increased dramatically over the past 15 years and is the principle method used to screen for colon cancer. Preparations used for colon cleaning have evolved over the past 30 years. Some preparations have been shown to be unsafe and are now used on a limited basis. There has been progress on limiting the volume required and on taste improvement.Areas covered in this review-This review provides an account of preparations used from 1980 when polyethylene glycol-based preparations became widely available, until the present day. The review highlights their mechanism of action and principle toxicities. The handling of solutes and solute-free fluid by the colon is also reviewed.What the reader will gain-The reader will gain a perspective on the factors considered in developing colonic purgatives and the rationale for choosing selected preparations based on patient factors such as age, co-morbidities, and concomitant medications.Take home message-Although generally safe and effective, colonic purgatives have both acute and permanent toxicities. The safest preparations utilize polyethylene glycol combined with a balanced electrolyte solution. Limitations of this preparation center on the volume required and poor taste. Alternative formulations are now available; however those using sodium phosphate have fallen out of favor due to a risk of renal toxicity.
Background Four liters of polyethylene glycol 3350 with balanced electrolytes for colonoscopy preparation has had poor acceptance. Another approach is the use of electrolyte-free PEG combined with 1.9L of Gatorade. Despite its widespread use, there are no data on metabolic safety and minimal data on efficacy. Our aim was to assess the efficacy and electrolyte safety of these two PEG-based preparations. Methods This was a prospective, randomized, single-blind, non-inferiority trial. Patients were randomized to 238g PEG + 1.9L Gatorade or 4L of PEG-ELS containing 236g PEG. Split dosing was not performed. On procedure day blood was drawn for basic chemistries. The primary outcome was preparation quality from procedure photos using the Boston Bowel Preparation Scale. Results We randomized 136 patients (66 PEG + Gatorade, 70 PEG-ELS). There were no differences in preparation scores between the two agents in the ITT analysis (7.2 ± 1.9 for PEG-ELS and 7.0 ± 2.1 for PEG + Gatorade; p = 0.45). BBPS scores were identical for those who completed the preparation and dietary instructions as directed (7.4 ± 1.7 for PEG-ELS, and 7.4 ± 1.8 for PEG + Gatorade; p = 0.98). There were no statistical differences in serum electrolytes between the two preparations. Patients who received PEG + Gatorade gave higher overall satisfaction scores for the preparation experience (p = 0.001), and had fewer adverse effects. Conclusions Use of 238g PEG + 1.9L Gatorade appears to be safe, better tolerated, and non-inferior to 4L PEG-ELS. This preparation may be especially useful for patients who previously tolerated PEG-ELS poorly.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.