A randomized, prospective trial on efficacy and tolerability of low-volume bowel preparation methods for colonoscopy

Yoo, In Kyung; Lee, Jong Soo; Chun, Hoon Jai; Jeen, Yoon Tae; Keum, Bora; Kim, Eun Sun; Choi, Hyuk Soon; Lee, Jae Min; Kim, Seung Han; Nam, Seung‐Joo; Kang, Hyung‐Sik; Lee, Hong Sik; Kim, Chang Duck; Um, Soon Ho; Seo, Yeon Seok; Ryu, Ho Sang

doi:10.1016/j.dld.2014.10.019

Cited by 32 publications

(42 citation statements)

References 32 publications

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“…In a large study, which was designed for noninferiority of PMC compared with a 2‐L PEG plus bisacodyl tablets regimen no difference between both groups was observed . Noninferiority or even superiority of PMC versus standard or low‐volume PEG solutions has also been demonstrated in other clinical trials . However, there is also evidence for a better efficacy of PEG (administered as standard 4‐L regimen) compared with PMC .…”

Section: Discussionmentioning

confidence: 97%

“…10 Noninferiority or even superiority of PMC versus standard or low-volume PEG solutions has also been demonstrated in other clinical trials. 7,11,[20][21][22] However, there is also evidence for a better efficacy of PEG (administered as standard 4-L regimen) compared with PMC. 23 The latter results are in line with our data.…”

Section: Bowel-cleansing Efficacy: Peg Superior To Pmcmentioning

confidence: 99%

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Single‐day sodium picosulfate and magnesium citrate versus split‐dose polyethylene glycol for bowel cleansing prior to colonoscopy: A prospective randomized endoscopist‐blinded trial

Klare

Poloschek

Walter

et al. 2015

J of Gastro and Hepatol

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Background and Aim: The intake of polyethylene glycol (PEG) prior colonoscopy is frequently associated with nausea and abdominal discomfort. The aim of this study was to investigate whether sodium picosulfate and magnesium citrate (PMC) is superior to a polyethylene glycol (PEG) preparation in regard to patient acceptance. Furthermore, it investigates possible differences in efficiency and patient safety. Methods: In a randomised, prospective, and endoscopist-blinded study patients were 1:1 randomized to either use PMC or 4-L PEG in order to prepare for colonoscopy. Cleansing regimes consisted of a split-dose administration in the PEG arm and standard administration in the PMC arm. Primary end point was proportion of patients evaluating the bowel preparation procedure as "very distressing," defined as ≥ 8 points on a 10-point numeric rating scale (NRS). Secondary end points were quality of bowel preparation and electrolyte parameters. Results: PMC bowel-cleansing procedure was better tolerated compared with PEG (PMC NRS<8 = 89.9% vs PEG NRS<8 = 79.2%, P = 0.037). Mean declines in serum sodium (ΔSodium PEG = −0.76 ± 3.07 vs ΔSodium PMC = −3.38 ± 3.56 mmol/L; P < 0.001), chloride (ΔChloride PEG = −1.00 ± 3.22 vs ΔChloride PMC = −3.49 ± 3.51 mmol/L; P < 0.001), and osmolality (ΔOsmolality PEG = −4.23 ± 6.82 vs ΔOsmolality PMC = −8.83 ± 7.43 mosmol/kg; P < 0.001) were higher in the PMC arm than in the PEG arm. Hyponatremia after bowel preparation occurred more often in PMC (21.2%) than in PEG (4.0%) (P < 0.001). Successful preparation was achieved more frequently in the PEG arm (42.9% vs 82.2%; P < 0.001). Conclusion: Standard picosulfate/magnesium citrate is better accepted than a split-dose PEG regimen. From the perspective of successful preparation and patients' safety, PEG is superior to PMC.

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Section: Discussionmentioning

confidence: 97%

Section: Bowel-cleansing Efficacy: Peg Superior To Pmcmentioning

confidence: 99%

Single‐day sodium picosulfate and magnesium citrate versus split‐dose polyethylene glycol for bowel cleansing prior to colonoscopy: A prospective randomized endoscopist‐blinded trial

Klare

Poloschek

Walter

et al. 2015

J of Gastro and Hepatol

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“…Low‐volume SPMC has been shown to have greater tolerability and equal or greater efficacy compared with sodium phosphate,22 2 L PEG and bisacodyl,5, 6 2 L PEG with ascorbic acid,23 3 L of sulfate‐free PEG,24 and 4 L PEG preparations 25. Non‐inferiority of SPMC to PEG has also recently been shown in a meta‐analysis 26.…”

Section: Discussionmentioning

confidence: 93%

White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial

et al. 2017

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Background and AimBowel preparations with polyethylene glycol (PEG) and clear fluids are often poorly tolerated. We compared an innovative low‐residue White Diet and low‐volume, split‐dose Picosalax with the standard preparation at our institution of day‐before clear fluids and combination PEG plus sodium picosulfate/magnesium citrate (SPMC).MethodsAdults undergoing morning colonoscopy were randomized to either the White Diet and split‐dose, two sachets of Picosalax (WD/PICO) or day‐before clear fluids and 1‐L PEG plus two sachets of SPMC (CF/PEG + SPMC). The primary endpoint was successful bowel preparation defined by an Ottawa bowel preparation score ≤ 6. An intention‐to‐treat analysis with a predefined non‐inferiority margin of 15% was used to compare efficacy.ResultsA total of 250 patients were randomized (125 WD/PICO and 125 CF/PEG + SPMC). WD/PICO was non‐inferior to CF/PEG + SPMC for successful bowel preparation by intention‐to‐treat analysis (58% WD/PICO vs 62% CF/PEG + SPMC, 95%CI: −14.2 to 6.2%) and per‐protocol analysis (64% WD/PICO vs 65% CF/PEG + SPMC, 95%CI: −11.3 to 9.4%). Patients in the WD/PICO group reported greater satisfaction with the diet (P < 0.001), greater ease of following the diet (P < 0.001), and improved experience compared with prior colonoscopy (P < 0.0001), less bloating (P = 0.02), less weakness (P = 0.046), less hunger (P < 0.0001), and less interference with daily activities (P = 0.001). Procedure/withdrawal times and adenoma detection rates were similar between groups.ConclusionBowel preparation with the White Diet and low‐volume, split‐dose Picosalax was preferred and better tolerated without detriment to bowel preparation success compared with clear fluids and combination PEG plus SPMC for morning colonoscopy.

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“…Another meta-analysis has shown that split-dose preparations provide with significantly better colon cleansing than daybefore preparations, either of PEG, sodium phosphate, or SPMC [16]. SPMC, either two or three sachets, and lowvolume PEG with ascorbic acid have been also compared, both being administered in split regimens, resulting in similar efficacy for bowel cleansing and superior acceptability for SPMC [17,18]. The results of these studies using same-day preparations of bowel cleansing solutions or a split-dose regimen suggest that the timing of the administration rather than the compound used for bowel cleansing is important for the quality of the preparation and it is clear that bowel preparation quality varies inversely with the duration of the interval between the last dose of the bowel preparation agent and the start of the colonoscopy [19].…”

Section: Discussionmentioning

confidence: 97%

A randomized trial to compare the efficacy and tolerability of sodium picosulfate-magnesium citrate solution vs. 4 L polyethylene glycol solution as a bowel preparation for colonoscopy

Muñoz-Navas

Calleja

Payeras

et al. 2015

Int J Colorectal Dis

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A randomized, prospective trial on efficacy and tolerability of low-volume bowel preparation methods for colonoscopy

Cited by 32 publications

References 32 publications

Single‐day sodium picosulfate and magnesium citrate versus split‐dose polyethylene glycol for bowel cleansing prior to colonoscopy: A prospective randomized endoscopist‐blinded trial

Single‐day sodium picosulfate and magnesium citrate versus split‐dose polyethylene glycol for bowel cleansing prior to colonoscopy: A prospective randomized endoscopist‐blinded trial

White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial

A randomized trial to compare the efficacy and tolerability of sodium picosulfate-magnesium citrate solution vs. 4 L polyethylene glycol solution as a bowel preparation for colonoscopy

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