Does Polyethylene Glycol (PEG) Plus Ascorbic Acid Induce More Mucosal Injuries than Split-Dose 4-L PEG during Bowel Preparation?

Abstract

Background/AimsThe aims of this study were to compare the bowel-cleansing efficacy, patient affinity for the preparation solution, and mucosal injury between a split dose of poly-ethylene glycol (SD-PEG) and low-volume PEG plus ascorbic acid (LV-PEG+Asc) in outpatient scheduled colonoscopies.MethodsOf the 319 patients, 160 were enrolled for SD-PEG, and 159 for LV-PEG+Asc. The bowel-cleansing efficacy was rated according to the Ottawa bowel preparation scale. Patient affinity for the preparation solution was assessed using a questionnaire. All mucosal injuries observed during colonoscopy were biopsied and histopathologically reviewed.ResultsThere was no significant difference in bowel cleansing between the groups. The LV-PEG+Asc group reported better patient acceptance and preference. There were no significant differences in the incidence or characteristics of the mucosal injuries between the two groups.ConclusionsCompared with SD-PEG, LV-PEG+Asc exhibited equivalent bowel-cleansing efficacy and resulted in improved patient acceptance and preference. There was no significant difference in mucosal injury between SD-PEG and LV-PEG+Asc. Thus, the LV-PEG+Asc preparation could be used more effectively and easily for routine colonoscopies without risking significant mucosal injury.

Low Volume Polyethylene Glycol (PEG) Plus Ascorbic Acid, a Valid Alternative to Standard PEG

“…compared the rate of mucosal injury, efficacy, and patient affinity for the preparation between 4-L PEG and 2-L PEG+Asc in consecutive outpatients. 8 With regard to mucosal inflammation, there was no significant difference between the two groups (4-L PEG vs 2-L PEG+Asc, 3.1% vs 3.7%). The total score of the Ottawa bowel preparation scale was not significantly different between the two groups (4.19±2.26 vs 4.41±2.07, p=0.376).…”

“…Second, split dose regimen of PEG, which is currently considered better than nonsplit dose regimen in bowel preparation efficacy, was applied to both groups in this study. 8 Thus, the results of this study might give us more useful information than previous studies with nonsplit dose regimen.…”

“…Third, the issue of diet control before bowel preparation needs to be further considered. Moon et al .’s study, 7 with a study setting similar to Kim et al .’s study 8 (all split dose for both 4-L PEG and 2-L PEG+Asc groups) indicated no significant difference in the quality of bowel preparation for any of the segments between the two groups. In the study by Moon et al ., 7 patients were limited to a low residue diet for the last 3 days and a liquid diet before 6:00 PM on the day before colonoscopy.…”

“…In the study by Moon et al ., 7 patients were limited to a low residue diet for the last 3 days and a liquid diet before 6:00 PM on the day before colonoscopy. However, Kim et al .’s study 8 allowed regular breakfast and lunch on the day before colonoscopy, which is liberal compared with other studies. 7 The diet protocol of this study seems very feasible for out-patients because it can reduce its interference in their daily lives.…”

“…However, the bowel cleansing score in the mid-colon of 2-L PEG+Asc group was significantly worse than that of 4-L PEG group. Despite some studies supporting liberal diet, 10 the results of Kim et al .’s study 8 might suggest 2-L PEG+Asc can have worse bowel preparation efficacy than 4-L PEG in the setting of a less restrictive diet. Further studies need to be conducted on this issue.…”