A randomized controlled trial evaluating a new 2-L PEG solution plus ascorbic acid vs 4-L PEG for bowel cleansing prior to colonoscopy

Valiante, F.; Pontone, Stefano; Hassan, Cesare; Bellumat, Angelo; Bona, Manuela De; Zullo, Angelo; Francesco, Vincenzo De; Boni, Michele De

doi:10.1016/j.dld.2011.10.007

Cited by 49 publications

(55 citation statements)

References 15 publications

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“…[3, 32, 40] Our data is also consistent with prior literature with respect to bowel preparation volume and quality of bowel cleansing; with 2 Liter PEG based regiments outperforming 4 Liter PEG and sodium phosphate based regiments. [39] Finally, our findings add to the substantial body of evidence linking short duration of time from last dose of purgative agent to start of colonoscopy with quality of colon preparation. [3, 40] While split dose preparation was not used at our center at the time of the study, our finding that preparation quality was significantly better for morning versus afternoon colonoscopies implies that split dose preparation would have been helpful in our population.…”

Section: Discussionmentioning

confidence: 57%

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The impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy

Kushnir

Bhat

Chokshi

et al. 2014

Digestive and Liver Disease

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Background Suboptimal colon preparation is a significant barrier to quality colonoscopy. The impact of pharmacologic agents associated with gastrointestinal dysmotility on quality of colon preparation has not been well characterized. Aims Evaluate impact of opiate pain medication and psychoactive medications on colon preparation quality in outpatient undergoing colonoscopy. Methods Outpatients undergoing colonoscopy at a single medical center during a 6-month period were retrospectively identified. Demographics, clinical characteristics and pharmacy records were extracted from electronic medical records. Colon preparation adequacy was evaluated using a validated composite colon preparation score. Results 2600 patients (57.3±12.9 years, 57% female) met the inclusion and exclusion criteria. 223 (8.6%) patients were regularly using opioids, 92 antipsychotics, 83 tricyclic antidepressants and 421 non-tricyclic antidepressants. Opioid use was associated with inadequate colon preparation both with low dose (OR=1.4, 95%CI 1.0-2.1, p=0.05) and high dose opioid users (OR=1.7, 95%CI 1.1-2.9, p=0.039) in a dose dependent manner. Other significant predictors of inadequate colon preparation included use of tricyclics (OR=1.9, 95%CI 1.1-3.0, p=0.012), non-tricyclic antidepressants (OR=1.5, 95%CI 1.1-2.0, p=0.013), and antipsychotic medications (OR=2.2, 95%CI 1.4-3.4, p=0.001). Conclusions Opiate pain medication use independently predict inadequate quality colon preparation in a dose dependent fashion; furthermore psychoactive medications have even more prominent effects and further potentate the negative impact of opiates with concurrent use.

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Section: Discussionmentioning

confidence: 57%

“…[1-3, 32, 38, 39] As in several prior reports, diabetes mellitus was a strong predictor of inadequate colon preparation. [1, 2] Increased BMI was strongly associated with inadequate colon preparation on univariate analysis, but BMI did not survive as an independent predictor on multivariate analysis in the current study (OR=1.0, CI 0.9=1.0).…”

Section: Discussionmentioning

confidence: 68%

The impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy

Kushnir

Bhat

Chokshi

et al. 2014

Digestive and Liver Disease

View full text Add to dashboard Cite

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“…Regarding bowel preparation scales, non-validated 5-point scales were used in three studies [27], [29], [39], the Aronchick scale in four [31], [33]–[35], the Ottawa scale in one [30], and a non-validated 3-point scale in the final study [32]. Two [31], [34] of the eleven studies compared low-volume PEG plus ascorbic acid with standard-volume PEG plus simethicone as bowel preparations for colonoscopy.…”

Section: Resultsmentioning

confidence: 99%

“…However, we did see that the low-volume group had significantly fewer overall adverse events and less vomiting and nausea than did the standard-volume group. This significant difference may result from the safety of ascorbic acid, even at high doses [54], [55], and the lower volume of PEG, reducing any PEG-based electrolyte or volume alterations [34].…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of Randomized Controlled Trials of Low-Volume Polyethylene Glycol plus Ascorbic Acid versus Standard-Volume Polyethylene Glycol Solution as Bowel Preparations for Colonoscopy

et al. 2014

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BackgroundStandard-volume polyethylene glycol (PEG) gut lavage solutions are safe and effective, but they require the consumption of large volumes of fluid. A new lower-volume solution of PEG plus ascorbic acid has been used recently as a preparation for colonoscopy.AimA meta-analysis was performed to compare the performance of low-volume PEG plus ascorbic acid with standard-volume PEG as bowel preparation for colonoscopy.StudyElectronic and manual searches were performed to identify randomized controlled trials (RCTs) that compared the performance of low-volume PEG plus ascorbic acid with standard-volume PEG as bowel preparation for colonoscopy. After a methodological quality assessment and data extraction, the pooled estimates of bowel preparation efficacy during bowel cleansing, compliance with preparation, willingness to repeat the same preparation, and the side effects were calculated. We calculated pooled estimates of odds ratios (OR) by fixed- and/or random-effects models. We also assessed heterogeneity among studies and the publication bias.ResultsEleven RCTs were identified for analysis. The pooled OR for preparation efficacy during bowel cleansing and for compliance with preparation for low-volume PEG plus ascorbic acid were 1.08 (95% CI = 0.98–1.28, P = 0.34) and 2.23 (95% CI = 1.67–2.98, P<0.00001), respectively, compared with those for standard-volume PEG. The side effects of vomiting and nausea for low-volume PEG plus ascorbic acid were reduced relative to standard-volume PEG. There was no significant publication bias, according to a funnel plot.ConclusionsLow-volume PEG plus ascorbic acid gut lavage achieved non-inferior efficacy for bowel cleansing, is more acceptable to patients, and has fewer side effects than standard-volume PEG as a bowel preparation method for colonoscopy.

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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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A randomized controlled trial evaluating a new 2-L PEG solution plus ascorbic acid vs 4-L PEG for bowel cleansing prior to colonoscopy

Cited by 49 publications

References 15 publications

The impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy

The impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy

A Meta-Analysis of Randomized Controlled Trials of Low-Volume Polyethylene Glycol plus Ascorbic Acid versus Standard-Volume Polyethylene Glycol Solution as Bowel Preparations for Colonoscopy

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

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