Comparison of colon-cleansing methods in preparation for colonoscopy - Comparative efficacy of solutions of mannitol, sodium picosulfate and monobasic and dibasic sodium phosphates
Abstract:PURPOSE: Colonoscopy plays an essential role in the therapeutic and diagnostic approach in various colonic pathologies, the aim of the present study was to compare three solutions and their efficacy for the bowel preparation in adult patients submitted to elective colonoscopy. METHODS: Sixty patients were randomly divided into three groups of 20 each. Each group was submitted to a bowel preparation with one of the following solutions: 10% manitol, sodium picosulphate or sodium phosphate. The parameters evaluat… Show more
“…1,12 Nevertheless, to be an test of excellence, the quality of the preparation is a determining factor, since patients whose preparation is regular have the effectiveness of their test affected, leading to an increase in costs and also a lower polyp detection rate. 11,12 Furthermore, solutions should be safe and e with acceptable patient tolerance. 15 Our results suggest that the ingestion of any of the four types of preparation is equally effective as for the quality of the cleansing of the colon.…”
Section: Discussionmentioning
confidence: 99%
“…7 Nevertheless, this solution is widely used in Brazil, since it is considered as a good intestinal preparation method, with the best cost and with appropriate effectiveness and safety. 1,11 Lactulose, nonabsorbable disaccharide, which undergoes bacterial action, was chosen as intestinal preparation because it is widely available, affordable costs and with effectiveness results similar to those of mannitol. 12 Lactitol, as well as lactulose, have both been used as options of intestinal preparation with good results reported by the manufacturer.…”
Introduction
Colonoscopy is the screening gold standard to investigate several conditions in the colon. The excellence of preparation is a determining factor for a quality colonoscopy.
Objective
Compare the quality of colon preparations for colonoscopy with different kinds of laxative medications in a public hospital of Belo Horizonte, Brazil.
Method
A prospective double blind randomized clinical trial was conducted from June 2016 to March 2017. A total of 117 Patients were randomised in four groups to receive a type of preparation (Sodium picosulfate, Mannitol, Lactitol, Lactulose). The patients answered a questionnaire and peripheral blood samples were collected before and after the preparation.The quality of the cleansing was accessed according to the Boston Bowel Preparation Scale.
Results
99.1% of patients have taken the recommended dose and 79.5% reported a good tolerability. Endoscopists performed complete colonoscopy in 89.7%, with an polipectomy rate of 47%. The total effectiveness rate of the solutions were 88%. There were no statistically significant differences between groups (
p
= 0.271). Regarding the laboratory parameters, differences were seen in the pre- and post-test values of sodium, chlorine and creatinine but without exceeding reference values.
Conclusion
The four preparations were effective for colon cleansing, with good acceptance, differing only as for costs.
“…1,12 Nevertheless, to be an test of excellence, the quality of the preparation is a determining factor, since patients whose preparation is regular have the effectiveness of their test affected, leading to an increase in costs and also a lower polyp detection rate. 11,12 Furthermore, solutions should be safe and e with acceptable patient tolerance. 15 Our results suggest that the ingestion of any of the four types of preparation is equally effective as for the quality of the cleansing of the colon.…”
Section: Discussionmentioning
confidence: 99%
“…7 Nevertheless, this solution is widely used in Brazil, since it is considered as a good intestinal preparation method, with the best cost and with appropriate effectiveness and safety. 1,11 Lactulose, nonabsorbable disaccharide, which undergoes bacterial action, was chosen as intestinal preparation because it is widely available, affordable costs and with effectiveness results similar to those of mannitol. 12 Lactitol, as well as lactulose, have both been used as options of intestinal preparation with good results reported by the manufacturer.…”
Introduction
Colonoscopy is the screening gold standard to investigate several conditions in the colon. The excellence of preparation is a determining factor for a quality colonoscopy.
Objective
Compare the quality of colon preparations for colonoscopy with different kinds of laxative medications in a public hospital of Belo Horizonte, Brazil.
Method
A prospective double blind randomized clinical trial was conducted from June 2016 to March 2017. A total of 117 Patients were randomised in four groups to receive a type of preparation (Sodium picosulfate, Mannitol, Lactitol, Lactulose). The patients answered a questionnaire and peripheral blood samples were collected before and after the preparation.The quality of the cleansing was accessed according to the Boston Bowel Preparation Scale.
Results
99.1% of patients have taken the recommended dose and 79.5% reported a good tolerability. Endoscopists performed complete colonoscopy in 89.7%, with an polipectomy rate of 47%. The total effectiveness rate of the solutions were 88%. There were no statistically significant differences between groups (
p
= 0.271). Regarding the laboratory parameters, differences were seen in the pre- and post-test values of sodium, chlorine and creatinine but without exceeding reference values.
Conclusion
The four preparations were effective for colon cleansing, with good acceptance, differing only as for costs.
“…In addition, only recently commercially specific colon cleansing products for colonoscopy have become available in Brazil. Several studies have reported on the use of mannitol in Brazil, demonstrating effectiveness in colon preparation, good tolerability and very low complication rates (3,11,16,17,19,24,27) . Methane production in the bowel is poorly understudied.…”
-Background -Adequate bowel preparation is critical for the quality of colonoscopy. Despite reported occurrence of colonic explosion due to methane and hydrogen production by bacterial fermentation during colonoscopy, gas exchange during the procedure is believed to be effective in lowering existing methane concentration, allowing for safe utilization of mannitol for bowel preparation. Thus, mannitol is widely used for bowel cleansing prior to colonoscopy, considering its low cost and effectiveness for bowel preparation.
“…Mannitol is a polyalcohol obtained by hydrogenating fructose from sucrose. It is a commonly used osmotic laxative associated with successful colonic cleansing compared to other solutions, although it is related to adverse events in more than 10% of cases (nausea, vomiting, headache, dehydration, and hypovolemia) [14][15][16]. Polyethylene glycol (polyethylene glycol [PEG]) has a molecular weight greater than 3,000 kDa and functions as a non-absorbable osmotic agent, retaining water molecules through hydrogen bonds; it is considered a good option for bowel preparation [14,15,17].…”
Colonoscopy is an important tool for diagnosing and treating bowel injuries and reducing colorectal cancer incidence. Adequate bowel preparation is necessary to ensure the effectiveness of the procedure for detecting injuries. In this trial the aim was to compare effectiveness of lactitol, mannitol, and polyethylene glycol (PEG) oral solutions for bowel cleansing prior to colonoscopy. This is a randomized, blinded clinical trial. The primary endpoint was to evaluate the adequacy of colon cleansing according to the Boston Bowel Preparation Scale (BBPS). A total of 294 patients were randomized into three groups. The overall adequacy of bowel cleansing was achieved in 98.8% in the mannitol, followed by 93.5% in the lactitol and 92.3% in the PEG group. When comparing lactitol and mannitol, the efficacy to bowel preparation was greater in the mannitol group, but without statistical significance (P=0.164). The adequacy to bowel preparation was slightly better in the mannitol group than PEG (98.8% vs. 92.2%, respectively), but with P-value of 0.073. In adjusted analysis, the results were similar. The frequency of hypernatremia after bowel preparation was 25.3% in the mannitol group, followed by 7.3% and 5.2% in the PEG and lactitol, respectively. Considering tolerance for bowel preparation solution there was no difference between the mannitol and lactitol groups (P=0.07); but lactitol was better tolerated when compared to PEG (P=0.001). In conclusion, mannitol, lactitol and PEG are effective as intestinal cleansing solutions before colonoscopy, but adverse events, taste and tolerability must be considered before choosing.
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