A randomized, controlled, double-blind trial of the adjunct use of tegaserod in whole-dose or split-dose polyethylene glycol electrolyte solution for colonoscopy preparation

Abdul‐Baki, Heitham; Hashash, Jana G.; El-Hajj, Ihab; Azar, Cecilio; Zahabi, Lara El; Mourad, Fadi H.; Barada, Kassem; Sharara, Ala I.

doi:10.1016/j.gie.2008.01.044

Cited by 64 publications

(54 citation statements)

References 20 publications

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“…High-volume PEG lavage solutions have become the mainstay of bowel preparation in many institutions because of their wellestablished efficacy and safety records. Several prospective randomized controlled studies demonstrated that a split-dose regimen of 4-L PEG achieved excellent or good bowel preparation in 73-96% of patients [9,17,[26][27][28] . A meta-analysis revealed that 4-L split-dose PEG is superior to other bowel preparation methods with an overall pooled odds ratio for excellent or good preparation quality of 3.5 [16] .…”

Section: Discussionmentioning

confidence: 99%

Impact of Bowel Preparation with Low-Volume (2-Liter) and Intermediate-Volume (3-Liter) Polyethylene Glycol on Colonoscopy Quality: A Prospective Observational Study

et al. 2015

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Background/Aims: Two-liter polyethylene glycol (PEG) is the most commonly used bowel-cleansing regimen in Taiwan, but its efficacy is unsatisfactory. The aim of this study was to compare 2-liter and 3-liter PEG in terms of their impact on colonoscopy quality among an average-risk population. Methods: Two-liter PEG was provided between August 2012 and May 2013, while 3-liter PEG was provided between June 2013 and March 2014. A split-dose regimen was provided for morning colonoscopy and a same-day regimen was provided for afternoon colonoscopy. The level of bowel cleansing was prospectively scored. Results: A total of 407 consecutive subjects completed the 2-liter regimen, and another 407 consecutive subjects completed the 3-liter regimen. The 3-liter group had a significantly higher rate of excellent or good preparations, equivalent to a Boston bowel preparation scale of ≥7, than the 2-liter group (90 vs. 73%, p < 0.0001). More subjects in the 3-liter preparation group compared with the 2-liter group had overall adenoma (70 vs. 54%, p < 0.0001), proximal adenoma (47 vs. 35%, p = 0.0006), sessile serrated adenoma (28 vs. 6%, p < 0.0001), and advanced adenoma (21 vs. 9%, p < 0.0001). Conclusions: Three-liter PEG provided better cleansing quality and higher adenoma detection rate than 2-liter PEG.

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Section: Discussionmentioning

confidence: 99%

Impact of Bowel Preparation with Low-Volume (2-Liter) and Intermediate-Volume (3-Liter) Polyethylene Glycol on Colonoscopy Quality: A Prospective Observational Study

et al. 2015

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“…Previous studies have shown that the split preparation is better than the conventional previous-evening preparation in terms of bowel preparation quality and patient compliance [14,17,18,25,26] . The split-dose option is also endorsed by the American College of Gastroenterology and is considered an optimal choice for colonoscopy [27] .…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have demonstrated that split dosing not only to improves patient acceptability, but also cleans the colon better [8] . Of 13 prospective, randomized studies done previously, 12 showed superior cleansing when whole or part of the bowel preparation was given in the morning of the scheduled colonoscopy [9][10][11][12][13][14][15][16][17][18][19][20][21] . However colonoscopies are often scheduled in the afternoon, and split dosing may not leave a clean colon by afternoon.…”

Section: Introductionmentioning

confidence: 99%

Comparison of split-dosingvsnon-split (morning) dosing regimen for assessment of quality of bowel preparation for colonoscopy

Shah

Desai

Samant

et al. 2014

WJGE

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AIM: To compare (using the Ottawa Bowel PreparationScale) the efficacy of split-dose vs morning administration of polyethylene glycol solution for colon cleansing in patients undergoing colonoscopy, and to assess the optimal preparation-to-colonoscopy interval. METHODS:Single-centre, prospective, randomized, investigator-blind stud in an academic tertiarycare centre. Two hundred patients requiring elective colonoscopy were assigned to receive one of the two preparation regimens (split vs morning) prior to colonoscopy. Main outcome measurements were bowel preparation quality and patient tolerability. RESULTS:Split-dose regimen resulted in better bowel preparation compared to morning regimen [Ottawa score mean 5.52 (SD 1.23) vs 6.02 (1.34); P = 0.017].On subgroup analysis, for afternoon procedures, both the preparations were equally effective (P = 0.756). There was no difference in tolerability and compliance between the two regimens. CONCLUSION:Overall, previous evening -same morning split-dosing regimen results in better bowel cleansing for colonoscopy compared to morning preparation. For afternoon procedures, both schedules are equally effective; morning preparation may be more convenient to the patient. Key words: Bowel preparation; Colonoscopy; Morning preparation; Split dose preparation; Preparation to colonoscopy interval Core tip: Split bowel reparation compared to single dose morning preparation resulted in a better bowel cleansing using the Ottawa Bowel Preparation Scale. The average score (± SD) using the Ottawa Scale was 6.02 ± 1.34 when morning preparation was given and 5.52 ± 1.23 when split preparation was given (P = 0.017). However, there was no statistical difference in the mean Ottawa score when the procedures were done in the afternoon with either the morning or the split preparation (6.09 vs 5.94, P = 0.756). Hence, AM only dosing is as effective as split dosing for patients scheduled for a colonoscopy in the afternoon.

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“…This agent is available without prescription and has been prescribed 'off label' as a bowel preparation agent. Split dosing of the purgative, that is, the administration of a portion of the purgative on the day of colonoscopy, has been consistently shown to improve bowel preparation quality [Abdul-Baki et al 2008;Kilgore et al 2011;Marmo et al 2010;Park et al 2007Park et al , 2010. With regard to precolonoscopy diet, several studies have examined the impact of alternative dietary recommendations (low-residue [Delegge and Kaplan, 2005;Rapier and Houston, 2006;Wu et al 2011] or fiber-free diet [Soweid et al 2010], light breakfast followed by clear liquids [Scott et al 2005], and regular diet followed by clear liquids or low-residue meals [Aoun et al 2005]) with a variety of purgative agents and found that bowel cleansing and patient tolerability were at least as good as with a clear liquid diet, if not better.…”

Section: Introductionmentioning

confidence: 99%

Split dose and MiraLAX-based purgatives to enhance bowel preparation quality becoming common recommendations in the US

Hillyer

Lebwohl

Basch

et al. 2012

Therap Adv Gastroenterol

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Abstract:Objectives: Rates of suboptimal bowel preparation up to 30% have been reported. Liberalized precolonoscopy diet, split dose purgative, and the use of MiraLAX-based bowel preparation (MBBP) prior to colonoscopy are recently developed measures to improve bowel preparation quality but little is known about the utilization prevalence of these measures. We examined the patterns of utilization of these newer approaches to improve precolonoscopy bowel preparation quality among American gastroenterologists. Methods: Surveys were distributed to a random sample of members of the American College of Gastroenterologists. Participants were queried regarding demographics, practice characteristics, and bowel preparation recommendations including recommendations for liberal dietary restrictions, split dose purgative, and the use of MBBP. Approaches were evaluated individually and in combination. Results: Of the 999 eligible participants, 288 responded; 15.2% recommended a liberal diet, 60.0% split dose purgative, and 37.4% MBBP. Diet recommendations varied geographically with gastroenterologists in the West more likely to recommend a restrictive diet (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.16-7.67) and physicians in the Northeast more likely to recommend a liberal diet more likely. Older physicians more often recommended split dosing (OR 1.04, 95% CI 1.04-2.97). Use of MBBP was more common in suburban settings (OR 2.14, 95% CI 1.23-3.73). Evidence suggests that physicians in private practice were more likely to prescribe split dosing (p = 0.03) and less often recommended MBBP (p = 0.02). Likelihood of prescribing MBBP increased as weekly volume of colonoscopy increased (p = 0.03). Conclusions: To enhance bowel preparation quality American gastroenterologists commonly use purgative split dosing. The use of MBBP is becoming more prevalent while a liberalized diet is infrequently recommended. Utilization of these newer approaches to improve bowel preparation quality varies by physician and practice characteristics. Further evaluation of the patterns of usage of these measures is indicated.

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A randomized, controlled, double-blind trial of the adjunct use of tegaserod in whole-dose or split-dose polyethylene glycol electrolyte solution for colonoscopy preparation

Cited by 64 publications

References 20 publications

Impact of Bowel Preparation with Low-Volume (2-Liter) and Intermediate-Volume (3-Liter) Polyethylene Glycol on Colonoscopy Quality: A Prospective Observational Study

Impact of Bowel Preparation with Low-Volume (2-Liter) and Intermediate-Volume (3-Liter) Polyethylene Glycol on Colonoscopy Quality: A Prospective Observational Study

Comparison of split-dosingvsnon-split (morning) dosing regimen for assessment of quality of bowel preparation for colonoscopy

Split dose and MiraLAX-based purgatives to enhance bowel preparation quality becoming common recommendations in the US

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