A Randomized Clinical Trial Evaluating Mannitol, Lactitol, and Polyethylene Glycol Macrogol as Oral Solutions for Colonoscopy Preparation

Abstract

Colonoscopy is an important tool for diagnosing and treating bowel injuries and reducing colorectal cancer incidence. Adequate bowel preparation is necessary to ensure the effectiveness of the procedure for detecting injuries. In this trial the aim was to compare effectiveness of lactitol, mannitol, and polyethylene glycol (PEG) oral solutions for bowel cleansing prior to colonoscopy. This is a randomized, blinded clinical trial. The primary endpoint was to evaluate the adequacy of colon cleansing according to the Boston Bowel Preparation Scale (BBPS). A total of 294 patients were randomized into three groups. The overall adequacy of bowel cleansing was achieved in 98.8% in the mannitol, followed by 93.5% in the lactitol and 92.3% in the PEG group. When comparing lactitol and mannitol, the efficacy to bowel preparation was greater in the mannitol group, but without statistical significance (P=0.164). The adequacy to bowel preparation was slightly better in the mannitol group than PEG (98.8% vs. 92.2%, respectively), but with P-value of 0.073. In adjusted analysis, the results were similar. The frequency of hypernatremia after bowel preparation was 25.3% in the mannitol group, followed by 7.3% and 5.2% in the PEG and lactitol, respectively. Considering tolerance for bowel preparation solution there was no difference between the mannitol and lactitol groups (P=0.07); but lactitol was better tolerated when compared to PEG (P=0.001). In conclusion, mannitol, lactitol and PEG are effective as intestinal cleansing solutions before colonoscopy, but adverse events, taste and tolerability must be considered before choosing.