Comparison of Two Bowel Preparations for Colonoscopy: Sodium Picosulphate With Magnesium Citrate Versus Sulphate-Free Polyethylene Glycol Lavage Solution

Regev, Arie; Fraser, Gerald; Delpre, G; A, Leiser; Neeman, A; Maoz, Eran; Anikin, Victor; Niv, Yaron

doi:10.1111/j.1572-0241.1998.00467.x

Cited by 63 publications

(31 citation statements)

References 19 publications

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“…Of all the problems that may be caused by volume load (nausea, vomiting, bloating, pain) only nausea and bloating occurred less frequently a er PMC. e same conclusion was drawn in the trial of Regev et al [11]. Better tolerance of PMC may be explained by properties of the compound itself.…”

Section: Discussionsupporting

confidence: 70%

“…However, the tolerance of PMC was better and with fewer side e ects such as nausea, vomiting or abdominal pain [9,10]. In a randomised trial [11] Regev et al found PMC to be associated with better bowel cleansing and patient acceptability than PEG. However, the authors compared various doses and duration of the preparation (3L of PEG in the a ernoon and 3 sachets of PMC from the morning the day before the colonoscopy).…”

Section: Discussionmentioning

confidence: 99%

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A Single or Split Dose Picosulphate/Magnesium Citrate Before Colonoscopy: Comparison Regarding Tolerance and Eficacy with Polyethylene Glycol. A Randomized Trial

Kojecký

Dolina

Kianička

et al. 2014

JGLD

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Background & Aims: To compare the eficacy and tolerance of sodium picosulphate/magnesium citrate(PMC) and polyethylene glycol (PEG) in a single or split dose regimen for colonoscopy bowel preparation.Methods: A prospective, randomized, endoscopist-blinded, multicenter study. The patients were randomly assigned to receive PMC (PMC4/0) or PEG (PEG4/0) in a single dose 4L day before colonoscopy or a split dose 2+2L PMC (PMC2/2) or 3+1L PEG (PEG3/1) one day before and in the morning before the colonoscopy. Each patient was interviewed to determine his/her subjective tolerance of the preparation before the procedure. The quality of bowel cleansing was assessed in a blinded test performed by multiple endoscopists using the Aronchick scale.Results: A total of 600 patients were enrolled, 88.2% were included in the analysis. Satisfactory bowel cleansing (Aronchick score 1 and 2) was signicantly more frequent when a split dose was used irrespective of the solution type (81.6% PMC2/2, 87.3% PEG3/1 vs. 73.0% PEG4/0, p = 0.024). In single dose regimens, PMC performed better than PEG (82.6% vs. 73.0%). Single or split dose PMC preparations were comparable. A PMC based solution was generally better tolerated than PEG regardless of the regimen used (p < 0.001). Nausea was reported mostly after the 4L PEG (32.8%, p < 0.001), incontinence after a split PMC dose (34.4%, p = 0.002), and bloating after the 4L PEG (38.0%, p < 0.001). There was no significant difference in the prevalence of vomiting.Conclusion: Colonic preparation with PMC yields similar results as a split PEG dose, regardless of whether PMC is administered in single or separate doses. PMC is better tolerated than any PEG-based preparation. A single 4L PEG the day before the colonoscopy is less appropriate for bowel cleansing.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

A Single or Split Dose Picosulphate/Magnesium Citrate Before Colonoscopy: Comparison Regarding Tolerance and Eficacy with Polyethylene Glycol. A Randomized Trial

Kojecký

Dolina

Kianička

et al. 2014

JGLD

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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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“…Nevertheless, it is a good colon cleanser and usually easier to ingest. 7 MC-SP complex acts locally in the colon as a combination of a stimulant laxative to increase frequency and strength of peristaltsis (sodium picosulfate component) and as an osmotic laxative to retain fluid in the colon (magnesium citrate component). 2 Compared with PEG and NaP solutions, it has similar bowel cleaning efficacy but the patient's compliance has been reported to be better than with PEG and NaP.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Hyponatremia after Bowel Preparation: Report of Two Cases and Literature Review

Costa

Soares

2017

Acta Med Port

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RESUMOIntrodução: A preparação intestinal para colonoscopia e/ou cirurgia coloretal pode induzir alterações hidro-eletrolíticas. O risco destas alterações parece estar relacionado com o tipo de preparação intestinal, idade e comorbilidades dos doentes. Caso Clínico: Os autores apresentam dois casos de hiponatrémia sintomática (sinais neurológicos focais e coma) após preparação intestinal com picossulfato de sódio/citrato de magnésio para colonoscopia. Em ambos os casos, verificou-se resolução completa e rápida do quadro clínico depois da correção da hiponatrémia com solução intravenosa de NaCl a 3%. Discussão: Os distúrbios eletrolíticos são mais frequentes nas preparações à base de fosfato de sódio e picossulfato de sódio/ citrato de magnésio, nos doentes com mais de 65 anos ou medicados com diuréticos tiazídicos, inibidores da enzima de conversão da angiotensina, beta-bloqueantes e antidepressivos e em doentes gastrectomizados. Nestes doentes devemos preferir preparações intestinais à base de macrogol (polyethylene glycol). Conclusão: Em doentes de risco (idade superior a 65 anos, medicados com diuréticos tiazídicos, IECAs, beta-bloqueantes e antidepressivos, e antecedentes de gastrectomia) recomendamos soluções à base de macrogol. Palavras-chave: Catárticos/efeitos adversos; Colonoscopia; Hiponatrémia ABSTRACT Introduction: Bowel preparation for colonoscopy and/or colorectal surgery can cause electrolyte imbalances. The risk of electrolyte imbalances seems to be related to the type of bowel cleansing solution, age of patients and comorbidities. Case Report: We report two cases of symptomatic hyponatremia (focal neurological signs and coma) after bowel preparation with sodium picosulfate/magnesium citrate for colonoscopy. In both cases, symptoms related to hyponatremia rapidly disappeared after sodium level correction with intravenous administration of hypertonic saline (3% NaCl). Discussion: Electrolyte imbalances are more common with sodium phosphate-based solutions (NaP) and sodium picosulfate/ magnesium citrate, in patients older than 65, in patients treated with thiazide diuretics, angiotensin-converting-enzyme inhibitor, betablockers or antidepressants and in gastrectomized patients. These patients should use macrogol-based solutions (polyethylene glycol). Conclusion:In patients at risk (patient > 65 years old, patients taking thiazide diuretics, angiotensin-converting-enzyme inhibitors, beta-blockers and antidepressants and with previous gastrectomy) we recommend macrogol-based solutions.

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Comparison of Two Bowel Preparations for Colonoscopy: Sodium Picosulphate With Magnesium Citrate Versus Sulphate-Free Polyethylene Glycol Lavage Solution

Abstract: Colonic preparation with SPS-Mg is better tolerated, associated with significantly fewer side effects, and results in higher quality bowel cleansing than preparation with PEG-EL.

Cited by 63 publications

References 19 publications

A Single or Split Dose Picosulphate/Magnesium Citrate Before Colonoscopy: Comparison Regarding Tolerance and Eficacy with Polyethylene Glycol. A Randomized Trial

A Single or Split Dose Picosulphate/Magnesium Citrate Before Colonoscopy: Comparison Regarding Tolerance and Eficacy with Polyethylene Glycol. A Randomized 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

Symptomatic Hyponatremia after Bowel Preparation: Report of Two Cases and Literature Review

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