Double-blind prospective randomized study comparing polyethylene glycol to lactulose for bowel preparation in colonoscopy

Menacho, Aline Moraes; Reimann, Adriano; Hirata, Lie Mara; Ganzerella, Caroline; Ivano, Flávio Heuta; Sugisawa, Ricardo

doi:10.1590/s0102-67202014000100003

Cited by 7 publications

(9 citation statements)

References 6 publications

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“…However, in another study done by Chun-Xia Li, the administration of the lactulose oral solution, as compared with the PEG solution, was associated with a lower incidence of nausea (23.81% in the Lac group vs. 58.54% in the PEG group, p=0008) [23]. Both lactulose solution and polyethylene solution equally caused mild abdominal discomfort comparable to the results obtained by Attar et al and Moraes in their respective studies [24][25] while there was no significant change in serum electrolytes in both the groups before and after bowel preparation, which is supported by the observations made by Shehata et al [26].…”

Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

“…In a study conducted by Menacho et al in 2014, out of 200 patients, 100 patients were given lactulose and 100 patients were given polyethylene glycol as a cleaning agent for bowel preparation, and the Aronchick scale was used for assessing bowel preparation. There was no difference in the quality of bowel preparation in both groups [25]. Chun-Xia Li in their study of 176 patients observed that the Lac group had superior bowel cleansing compared to the PEG group (BBPS scores: 6 88 ± 1 78 vs 7 95±1 40, p-value = 0.001) [23].…”

Section: Discussionmentioning

confidence: 99%

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Oral Lactulose vs. Polyethylene Glycol for Bowel Preparation in Colonoscopy: A Randomized Controlled Study

Jagdeep¹,

Sawant²,

Lal³

et al. 2021

Cureus

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BackgroundColonoscopy is the method of choice to evaluate colonic mucosa and the distal ileum, allowing the diagnosis and treatment of many diseases. Appropriate bowel preparation necessitates the use of laxative medications, preferentially by oral administration. These include polyethylene glycol (PEG), sodium picosulfate, and sodium phosphate (NaP). Lactulose, a semi-synthetic derivative of lactose, undergoes fermentation, acidifying the gut environment, stimulates intestinal motility, and increases osmotic pressure within the lumen of the colon. MethodsIn this prospective randomized controlled study, we analyzed 40 patients who presented with symptomatic bleeding per rectum and underwent bowel preparation either with lactulose or polyethylene glycol for colonoscopy. The quality of bowel preparation and other variables like palatability, discomfort, and electrolyte levels were analyzed. ResultsThe majority of the patients (90%) were comfortable with the taste of lactulose solution, whereas the PEG group patients (55%) were equally divided on its palatability. On lactulose consumption, 40% of patients reported nausea/vomiting and around 10% of patients complained of abdominal discomfort. Serum sodium levels showed insignificant changes from 4.33 ± 0.07 mEq/L to 4.21 ± 0.18 mEq/L while potassium also remained similar from 4.26 ± 0.03 mEq/L to 4.22 ± 0.17 mEq/L. The mean Boston Bowel Preparation Score (BBPS) in patients who received lactulose solution was 6.25 ± 0.786 and in those who received PEG solution, it was 6.35 ± 0.813 (P-value = 0.59). ConclusionsLactulose is a significantly more palatable form of bowel preparation and causes minor discomfort. It has a good bowel cleansing action comparable to PEG without causing any hemodynamic changes. It can be considered a cheaper and safe alternative for bowel preparation in colonoscopy in low-resource settings.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Oral Lactulose vs. Polyethylene Glycol for Bowel Preparation in Colonoscopy: A Randomized Controlled Study

Jagdeep¹,

Sawant²,

Lal³

et al. 2021

Cureus

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“…Non-polypoid lesions are more common on the right side of the colon and failure of colonoscopy to diagnose such lesions could partially explain the development of interval more aggressive neoplasms [ 24 ]. Failure to diagnose these lesions could be attributed to inadequate bowel preparation [ 25 , 26 ], colonoscopy technique, colonoscope withdrawal time [ 27 ], and polyp location [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Hyoscine Bromide Use on Polyp Detection Rate During Colonoscopy: A Systematic Review and Meta-Analysis

2018

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BackgroundColorectal cancer (CRC) is a leading cause of death worldwide. Polyp detection rate (PDR) and adenoma detection rate (ADR) are key focus in endoscopic research for CRC screening and prevention. Use of anti-spasmodic agents during colonoscopy to help identify adenomas and polyps has remained a controversial topic. Hyoscine butyl bromide (HBB) is the most commonly used anti-spasmodic agent in patients undergoing colonoscopy. Some randomized controlled trials (RCTs) have questioned the clinical efficacy and safety of routine use of HBB for polyp and adenoma detection rates.MethodsWe conducted a systematic search in PubMed and MEDLINE from inception until February 10, 2018, for studies which compared HBB with placebo. We used RevMan version 5.3 for analysis. Procedural end-points were polyps, adenomas, and advanced adenoma detection rates, mean number of polyps detected and cecal intubation time.ResultsWe included seven RCTs with 2,588 patients in our analysis. A total of 1,301 patients were randomized to HBB arm and 1,287 to the placebo arm. There was no significant difference in the primary outcome of polyp detection rate, 654 in HBB group vs. 616 in the placebo group, (odds ratio (OR) = 1.11, confidence interval (CI) = 0.93 - 1.34, P = 0.25). There was no difference in secondary outcomes of adenoma detection rate, 430 in HBB group vs. 396 in the placebo group, (OR = 1.06, CI = 0.89 - 1.26, P = 0.51), advanced adenoma detection rate, 92 in HBB vs. 95 in placebo group (OR = 0.95, CI = 0.70 - 1.30, P = 0.76), mean number of polyps detected (point estimate = 0.12, CI = 0.00 - 0.23, P = 0.05), adenomatous polyps (OR = 0.84, CI = 0.39 - 1.81, P = 0.65) and cecal intubation time (point estimate = 0.73, CI = -1.98 - 0.52, P = 0.25) between the two groups.ConclusionsThe use of HBB in patients undergoing colonoscopy does not appear to improve polyp or adenoma detection rates. It showed a non-significant trend of increased mean number of polyps detected with HBB.

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“…Many factors could contribute to the failure to diagnose these lesions, including inadequate bowel preparation 7 , 8 , colonoscopy technique 9 , colonoscope withdrawal time 10 and polyp location 11 , 12 . New techniques have been developed to increase the ADR, such as high-definition colonoscopes 13 , chromoendoscopy 14 , G-EYE colonoscope 15 , the Third Eye colonoscope 16 , full spectrum endoscopy 17 , water-immersion colonoscopy 18 , retroflexion in the right colon 19 , cap-assisted colonoscopy 20 , endocuff-assisted colonoscopy 21 , and endorings 22 .…”

Section: Introductionmentioning

confidence: 99%

Hyoscine butylbromide for colorectal polyp detection: prospective, randomized, placebo-controlled trial

Santos¹,

Moreira²,

Pereira-Lima³

et al. 2017

Clinics

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OBJECTIVES:The removal of pre-malignant colorectal lesions prevents cancer. Hyoscine has been proposed as a means of improving diagnosis by reducing colonic movements. The aim of this study was to analyze whether this anti-spasmodic enhances the detection of pre-malignant colorectal lesions.METHODS:In a randomized, double-blinded fashion patients received hyoscine or a saline solution in all consecutive colonoscopies in which the cecum was reached. Lesions were analysed with respect to number, size, location, histology and capillary pattern.RESULTS:A total of 440 colonoscopies were randomized. The overall polyp detection rate (PDR) and the adenoma detection rate (ADR) were 65.2% and 49.3%, respectively. In the hyoscine group, non-polypoid lesions were detected significantly more often (p=0.01). In the placebo group 281 lesions were diagnosed (202 adenomas) and in the hyoscine group 282 lesions were detected (189 adenomas) (p=0.23). The PDR and ADR were similar between the placebo and hyoscine groups (64% vs 66% and 50% vs 47%, respectively). No differences were observed between the two groups in the advanced-ADR or advanced neoplasia detection rate, as well the mean numbers of polyps, adenomas, advanced adenomas and advanced neoplasias detected per patient. The administration of hyoscine also did not improve the diagnostic accuracy of digital chromoendoscopy. The presence of adenomatous polyps in the right colon was detected significantly more frequently in the hyoscine group (OR 5.41 95% CI 2.7 - 11; p<0.01 vs OR 2.3 95% CI 1.1 - 4.6; p=0.02).CONCLUSION:The use of hyoscine before beginning the withdrawal of the colonoscope does not seem to enhance the PDR and the ADR.

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Double-blind prospective randomized study comparing polyethylene glycol to lactulose for bowel preparation in colonoscopy

Cited by 7 publications

References 6 publications

Oral Lactulose vs. Polyethylene Glycol for Bowel Preparation in Colonoscopy: A Randomized Controlled Study

Oral Lactulose vs. Polyethylene Glycol for Bowel Preparation in Colonoscopy: A Randomized Controlled Study

Impact of Hyoscine Bromide Use on Polyp Detection Rate During Colonoscopy: A Systematic Review and Meta-Analysis

Hyoscine butylbromide for colorectal polyp detection: prospective, randomized, placebo-controlled trial

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