Combination of bisacodyl suppository and 1 L polyethylene glycol plus ascorbic acid is a non‐inferior and comfortable regimen compared to 2 L polyethylene glycol plus ascorbic acid

Abstract

Background and Aim: Appropriate bowel cleansing before colonoscopy is an important factor in increasing the detection rate of lesions. Low-volume polyethylene glycol (PEG) plus ascorbic acid (PEG-Asc) reduces the dosage of bowel preparation agent, but still presents discomfort to patients. The primary aim of the present study was to compare the efficacy of bowel cleansing between 2 L PEG-Asc (control) and 1 L PEG-Asc with bisacodyl suppository (suppository) groups, and the secondary aim was to investigate complications and tolerability between the two groups.Methods: This was a single-center prospective randomized controlled study. We identified 168 patients scheduled for colonoscopy between August 2017 and January 2018 and randomly assigned them to the control or to the suppository groups. Efficacy of bowel cleansing was assessed using the Boston Bowel Preparation Scale (BBPS), and side-effects were surveyed using questionnaires. Results: No significant difference was detected in baselinecharacteristics including insertion and withdrawal times, and adenoma detection rates between the two groups. Total BBPS score was 7.93 AE 1.06 and 7.74 AE 1.02 in the control and suppository groups, respectively (P = 0.22). Incidence of abdominal pain and nausea was not statistically different, whereas that of sleep disturbance and anal discomfort was higher in the control group. (P = 0.00). Conclusions:One liter PEG-Asc with bisacodyl suppository resulted in an equivalent bowel-cleansing outcome with reduced patient discomfort compared to 2 L PEG-Asc. Therefore, PEG-Asc with bisacodyl suppository represents a potential alternative and increases patient compliance with bowel preparation. Bowel Preparation Scale scores and complications associated with bowel preparations were recorded at Digestive Endoscopy 2020; 32: 600-607Suppository and 1 L polyethylene glycol 601

Comparison of 1L Adjuvant Auxiliary Preparations with 2L Solely Polyethylene Glycol plus Ascorbic Acid Regime for Bowel Cleaning: A Meta-analysis of Randomized, Controlled Trials

“…The results of this study showed no statistical differences, while only a conservative estimation can be done due to limited sample size in this part. Based on the current available literature, our results supported the use of additional adjuvants solely with PEG-Asc solution [17][18][19][20][21]. According to a hypothesis, the cathartic effect of bisacodyl and prucalopride might be due to its cathartic or prokinetic mechanism, which in turn changes the motor patterns in the colon and promotes the intestinal movement [31,32].…”

“…Almost all the studies included in this meta-analysis were internally consistent in these respects in order to eliminate the influence of these confounding factors on the results. Nevertheless, in Kim's trial, a statistically significant difference was observed in the mean age of patients [20]. Our study results showed that patients in the 2L group (48.14 vs. 52.88) were younger, which was under the common cut-off, and the results ultimately showed no significant difference between the two groups [22].…”

“…The included studies have individually evaluated the effectiveness of adjuvant drugs in reducing the intestinal preparation solutions, one with prucalopride [17] and the remaining four with bisacodyl [18][19][20][21]. Our review highlighted the feasibility of the use of combination for bowel preparation after summarizing in 1013 patients with the results (either primary or secondary outcomes).…”

“…Another marked advantage of this protocol is the willingness of patients to repeat, enrollment of sufficient number of patients, and preference for lower-dose regimens is visibly demonstrated [26]. The lower-dose regimen that substitutes an adjuvant for large quantities of solution the day before colonoscopy, particularly the additional suppository using on the day of colonoscopy, can reduce the disturbance on sleep [20]. Secondly, it reduces the consumption of these unpalatable liquids, which can reduce the psychological burden on patients.…”

Nobiletin promotes the pyroptosis of breast cancer via regulation of miR‐200b/JAZF1 axis

“…23 Furthermore, the protein ASC is also associated with cancer cell death. 24 Based on these findings, some scientists have paid attention on regulatory effect of ASC on drug intervention in cell pyroptosis. In addition, Miyata et al found that upregulation of ASC could significantly inhibit the progression of cancer.…”