A new low-volume isosmotic polyethylene glycol solution plus bisacodyl versus split-dose 4L polyethylene glycol for bowel cleansing prior to colonoscopy: A randomised controlled trial

Cesaro, Paola; Hassan, Cesare; Spada, Cristiano; Petruzziello, Lucio; Vitale, Giovanna; Costamagna, Guido

doi:10.1016/j.dld.2012.07.011

Cited by 40 publications

(51 citation statements)

References 20 publications

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“…Our search strategy identified 535 potentially relevant records after excluding duplicates. After careful review, 36 studies that met inclusion criteria were further evaluated for eligibility, and 12 full‐text articles from 2009 to 2017 were included in this meta‐analysis . The review process is illustrated by a flowchart of Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…One meta‐analysis showed that oral simethicone helps reduce bubbles and improves visibility in upper gastrointestinal endoscopy, but the ADR was not evaluated because few studies had addressed this issue at the time it was published. Several subsequent randomized controlled trials evaluated the bowel cleansing effects of adjuvant simethicone; however, whether it had a beneficial role in ADR or polyp detection rate (PDR) had yet to be confirmed …”

Section: Introductionmentioning

confidence: 99%

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The benefit of adding oral simethicone in bowel preparation regimen for the detection of colon adenoma: A systematic review and meta‐analysis

Yeh

Hsu

Tseng

et al. 2018

J of Gastro and Hepatol

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Background and Aim Simethicone is an anti‐foaming agent commonly used during colonoscopy. Although several randomized trials have shown that oral simethicone in the bowel preparation regimen may improve bowel cleanness, whether it improves adenoma detection rate (ADR) or polyp detection rate remains undetermined. The aim of this study was to determine if oral simethicone in bowel preparation regimen before colonoscopy improves the ADR. Methods A comprehensive literature review was conducted using PubMed, SDOL, Cochrane Library, and ProQuest databases through December 2017. Randomized controlled trials that compared bowel preparation regimens with simethicone versus those without it were included. Effect estimates from each study were extracted and underwent meta‐analysis using appropriate models. The primary outcomes were ADR and polyp detection rate, and secondary outcomes included bowel preparation, bubble score, and withdrawal time. Results Twelve published randomized controlled studies with 6003 participants were included for meta‐analysis. There was no difference in the overall ADR (pooled risk ratio = 1.06, 95% confidence interval = 0.91–1.24) and right‐side ADR (risk ratio = 1.50, 95% confidence interval = 0.82–2.75) between the groups with or without simethicone. However, the addition of simethicone improved adenoma detected per patient (2.20 ± 1.36 vs 1.63 ± 0.89) according to one of the included studies. Meta‐regression revealed that the baseline ADR < 25% of the included studies was associated with significant benefit of oral simethicone; the number needed to treat was 15. Conclusions The adjunction of oral simethicone significantly improved bowel preparation quality and might benefit adenoma detection in specific settings with low baseline ADR.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The benefit of adding oral simethicone in bowel preparation regimen for the detection of colon adenoma: A systematic review and meta‐analysis

Yeh

Hsu

Tseng

et al. 2018

J of Gastro and Hepatol

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“…Twenty-one trials included analyzable bowelcleanliness outcomes (64)(65)(66)(67)(68)(69)(70)(71)(72)(74)(75)(76)79,(81)(82)(83)(84)(85)(86)88,89 ). High-volume PEG-ELS did not show a signifi cant increase in bowel cleanliness (OR, 1.03; 95% CI, 0.80-1.32).…”

Section: Polyethylene Glycol-electrolyte Lavage Solutionmentioning

confidence: 89%

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Johnson

Barkun

Cohen

et al. 2014

American Journal of Gastroenterology

136

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The American Journal of GASTROENTEROLOGY PRACTICE GUIDELINESColorectal cancer (CRC) is the second leading cause of cancerrelated deaths in the United States ( 1 ). Colonoscopy can prevent CRC by the detection and removal of precancerous lesions. In addition to CRC screening and surveillance, colonoscopy is used widely for the diagnostic evaluation of symptoms and other positive CRC screening tests. Regardless of indication, the success of colonoscopy is linked closely to the adequacy of preprocedure bowel cleansing.Unfortunately, up to 20-25% of all colonoscopies are reported to have an inadequate bowel preparation ( 2,3 ). Th e reasons for this range from patient-related variables such as compliance with preparation instructions and a variety of medical conditions that make bowel cleansing more diffi cult to unit-specifi c factors (eg, extended wait times aft er scheduling of colonoscopy) ( 4 ). Adverse consequences of ineff ective bowel preparation include lower adenoma detection rates, longer procedural time, lower cecal intubation rates, increased electrocautery risk, and shorter intervals between examinations ( 3,5-7 ).Bowel preparation formulations intended for precolonoscopy cleansing are assessed based on their effi cacy, safety, and tolerability. Lack of specifi c organ toxicity is considered to be a prerequisite for bowel preparations. Between cleansing effi cacy and tolerability, however, the consequences of inadequate cleansing suggest that effi cacy should be a higher priority than tolerability. Consequently, the choice of a bowel cleansing regimen should be based on cleansing effi cacy fi rst and patient tolerability second. However, effi cacy and tolerability are closely interrelated. For example, a cleansing agent that is poorly tolerated and thus not fully ingested may not achieve an adequate cleansing.Th e goals of this consensus document are to provide expert, evidence-based recommendations for clinicians to optimize colonoscopy preparation quality and patient safety. Recommendations are provided using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) scoring system, which weighs the strength of the recommendation and the quality of the evidence ( 8 ). METHODS Search StrategyComputerized medical literature searches were conducted from January 1980 (fi rst year of approval of polyethylene glycol-electrolyte lavage solution [PEG-ELS]-based preparation by the Food and Drug Administration [FDA]) up to August 2013 using MEDLINE, PubMed EMBASE, Scopus, CENTRAL, and ISI Web of knowledge. We used a highly sensitive search strategy to identify reports of randomized controlled trials ( 9 ) with a combination of medical subject headings adapted to each database and text words related to colonoscopy and gastrointestinal agents, bowel preparation, generic name, and brand name. Th e complete search terms are available in Appendix A. Recursive searches and cross-referencing also were performed using a "similar articles" function; hand searches of articles were identifi ed aft er an i...

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“…Recent studies have shown varying degrees of efficacy between the high and low-volume regimens, usually revealing an insignificant difference in expert-rated opinions on the quality of the bowel preparation [6–8]. Preparations are also more effective when given in a split-dose schedule as compared to a non-split-dosage schedule [9].…”

Section: Introductionmentioning

confidence: 99%

A low-volume polyethylene glycol solution was associated with an increased suboptimal bowel preparation rate but had similar recommendations for an early repeat colonoscopy, procedure times, and adenoma detection rates

et al. 2017

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Background/AimsLow-volume polyethylene glycol (PEG) bowel preparations are better tolerated by patients than high-volume preparations and may achieve similar preparation quality. However, there is little data comparing their effects on a recommendation for an early repeat colonoscopy (because of a suboptimal preparation), procedure times, adenoma detection rate (ADR), and advanced adenoma detection rate (AADR).MethodsThis is a retrospective cohort study of outpatient colonoscopies performed during a one-year period at a single academic medical center in which low-volume MoviPrep® (n = 1841) or high-volume Colyte® (n = 1337) was used. All preparations were split-dosed. Appropriate covariates were included in regression models assessing suboptimal preparation quality (fair, poor, or inadequate), procedure times, recommendation for an early repeat colonoscopy, ADR, and AADR.ResultsMoviPrep® was associated with an increase in having a suboptimal bowel preparation (OR 1.36; 95% CI: 1.06–1.76), but it was not associated with differences in insertion (p = 0.43), withdrawal (p = 0.22), or total procedure times (p = 0.10). The adjusted percentage with a suboptimal preparation was 11.7% for patients using MoviPrep® and 8.8% for patients using Colyte®. MoviPrep® was not associated with a significant difference in overall ADR (OR 0.93; 95% CI: 0.78–1.11), AADR (OR 1.18; 95% CI: 0.87–1.62), or recommendation for early repeat colonoscopy (OR 1.16; 95% CI: 0.72–1.88).ConclusionsMoviPrep® was associated with a small absolute increase in having a suboptimal preparation, but did not affect recommendations for an early repeat colonoscopy, procedure times, or adenoma detection rates. Mechanisms to reduce financial barriers limiting low-volume preparations should be considered because of their favorable tolerability profile.

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A new low-volume isosmotic polyethylene glycol solution plus bisacodyl versus split-dose 4L polyethylene glycol for bowel cleansing prior to colonoscopy: A randomised controlled trial

Cited by 40 publications

References 20 publications

The benefit of adding oral simethicone in bowel preparation regimen for the detection of colon adenoma: A systematic review and meta‐analysis

The benefit of adding oral simethicone in bowel preparation regimen for the detection of colon adenoma: A systematic review and meta‐analysis

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

A low-volume polyethylene glycol solution was associated with an increased suboptimal bowel preparation rate but had similar recommendations for an early repeat colonoscopy, procedure times, and adenoma detection rates

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