Colonoscopy Preparation: Polyethylene Glycol with Gatorade Is as Safe and Efficacious as Four Liters of Polyethylene Glycol with Balanced Electrolytes

Abstract

Background Four liters of polyethylene glycol 3350 with balanced electrolytes for colonoscopy preparation has had poor acceptance. Another approach is the use of electrolyte-free PEG combined with 1.9L of Gatorade. Despite its widespread use, there are no data on metabolic safety and minimal data on efficacy. Our aim was to assess the efficacy and electrolyte safety of these two PEG-based preparations. Methods This was a prospective, randomized, single-blind, non-inferiority trial. Patients were randomized to 238g PEG + 1.9L Gatorade or 4L of PEG-ELS containing 236g PEG. Split dosing was not performed. On procedure day blood was drawn for basic chemistries. The primary outcome was preparation quality from procedure photos using the Boston Bowel Preparation Scale. Results We randomized 136 patients (66 PEG + Gatorade, 70 PEG-ELS). There were no differences in preparation scores between the two agents in the ITT analysis (7.2 ± 1.9 for PEG-ELS and 7.0 ± 2.1 for PEG + Gatorade; p = 0.45). BBPS scores were identical for those who completed the preparation and dietary instructions as directed (7.4 ± 1.7 for PEG-ELS, and 7.4 ± 1.8 for PEG + Gatorade; p = 0.98). There were no statistical differences in serum electrolytes between the two preparations. Patients who received PEG + Gatorade gave higher overall satisfaction scores for the preparation experience (p = 0.001), and had fewer adverse effects. Conclusions Use of 238g PEG + 1.9L Gatorade appears to be safe, better tolerated, and non-inferior to 4L PEG-ELS. This preparation may be especially useful for patients who previously tolerated PEG-ELS poorly.

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

“…In the remaining 4 studies, including 1 study that used 306 g rather than 238 g, the proportion of patients having an adequate bowel preparation was comparable with PEG-3350 powder and 4 L PEG-ELS (29)(30)(31). Tolerability based on taste and overall experience was better with PEG-3350 powder than with 4 L PEG-ELS in 4 studies ( 73,80,84,161 ), and no diff erence in tolerability was observed in 1 series ( 69 ).…”

“…Although hyponatremia is a potential risk when using a hypotonic lavage solution such as PEG powder, no statistical diff erences in serum electrolyte levels were observed in 3 studies that compared PEG powder vs. 4 L PEG-ELS ( 80,84,161 ). Reports of hyponatremia have occurred when administered the evening before, but not with split-dose regimens ( 162 ) .…”

Polyethylene Glycol-3350 (Miralax®)+1.9-L sports drink (Gatorade®)+2 tablets of bisacodyl results in inferior bowel preparation for colonoscopy compared with Polyethylene Glycol-Ascorbic Acid (MoviPrep®)

“…Previous studies compared a PEG-3350+SD regimen vs. 4-L PEG-ELS (GoLytely), demonstrating increased patient satisfaction and tolerability in the PEG-3350 group while producing similar rates of high-quality bowel preparation (15)(16)(17). We chose to compare PEG-3350+SD+B to the FDA-approved PM/AM split-dose PEG-AA.…”

“…One study using PEG-3350 in a community setting resulted in good-quality bowel preparations and patient tolerability (14). Subsequent studies compared PEG-3350+SD with 4-L PEG-ELS, some concluding PEG-3350 as a non-inferior bowel preparation (15)(16)(17), while others showed higher quality preparations with 4-L PEG-ELS (10,18). There have been no head-tohead comparative trials of PEG-3350+SD+B vs. PEG-AA.…”

Comparison of Four Different Colonic Preps in 3595 Patients at A University Center: A Real Life Experience

“…However, this difference was not seen for theSD regimen of PEGAand the clinical relevance of a slightly lower score is lessened given that the endoscopist can deal with residual stool at the time of the procedure. Prior studies also have compared 4-L PEG solutions (PEG-ELS) with 2-L PEG solutions and bisacodyl tablets (PEG) and found no significant differences in bowel preparation effectiveness using the BBPS scale [20,21] . However, one randomized trial, and a recent metaanalysis of PEG bowel preparations, demonstrated statistically significantly fewer satisfactory bowel preparation scores as compared to PEG-ELS solutions using either the BBPS or Ottawa Preparation Scale (OPS) [22,23] .…”