Same-day 2-L PEG-citrate-simethicone plus bisacodylvssplit 4-L PEG: Bowel cleansing for late-morning colonoscopy

Abstract

AIM:To evaluate the efficacy, tolerability, acceptability and feasibility of bisacodyl plus low volume polyethyleneglycol-citrate-simeticone (2-L PEG-CS) taken the same day as compared with conventional split-dose 4-L PEG for late morning colonoscopy. METHODS:Randomised, observer-blind, parallel group, comparative trial carried out in 2 centres. Out patients of both sexes, aged between 18 and 85 years, undergoing colonoscopy for diagnostic investigation, colorectal cancer screening or follow-up were eligible. The PEG-CS group received 3 bisacodyl tablets (4 tablets for patients with constipation) at bedtime and 2-L PEG-CS in the morning starting 5 h before colonoscopy. The control group received a conventional 4-L PEG formulation given as split regimen; the morning dose was taken with the same schedule of the low volume preparation. The Ottawa Bowel Preparation Scale (OBPS) score was used as the main outcome measure. RESULTS:A total of 164 subjects were enrolled and 154 completed the study; 78 in the PEG-CS group and 76 in the split 4-L PEG group. The two groups were comparable at baseline. The OBPS score in the PEG-CS group (3.09 ± 2.40) and in the PEG group (2.39 ± 2.55) were equivalent (difference +0.70; 95%CI: -0.09-1.48). This was confirmed by the rate of successful bowel cleansing in the PEG-CS group (89.7%) and in the PEG group (92.1%) (difference -2.4%; 95%CI: -11.40-6.70). PEG-CS was superior in terms of mucosa visibility compared to PEG (85.7% vs 72.4%, P = 0.042). There were no significant differences in caecum intubation rate, time to reach the caecum and withdrawal time between the two groups. The adenoma detection rate was similar (PEG-CS 43.6% vs PEG 44.7%). No serious adverse events occurred. No difference was found in tolerability of the bowel preparations. Compliance was equal in both groups: more than 90% of subjects drunk the whole solution. Willingness to repeat the same bowel preparations was about 90% for both regimes. CONCLUSION:Same-day PEG-CS is feasible, effective as split-dose 4-L PEG for late morning colonoscopy and does not interfere with work and daily activities the day before colonoscopy. Key words: Bowel preparation; Polyethyleneglycol; Simethicone; Ottawa Bowel Preparation Scale; Colonoscopy Core tip: The timing of bowel preparation is fundamental for high quality colonoscopy and also for patient satisfaction. Split-dose preparation improves the rate of adequate cleansing and patient compliance. This study shows that the same-day low volume polyethyleneglycol-citrate-simeticone (PEG-CS) plus bisacodyl tablets is feasible, and as effective as split 4-L PEG. The low volume bowel preparation taken the same day of the exam may be an attractive option for late morning September 16, 2013|Volume 5|Issue 9|

Effect of supplemental simethicone for bowel preparation on adenoma detection during colonoscopy: A meta‐analysis of randomized controlled trials

“…Additionally, according to the forest plot, it is obvious that, excepting the two RCTs conducted by Matro et al . and de Leone et al ., the other four trials reported numerically higher ADRs during colonoscopy in the SIM group. However, when data from all the six RCTs were pooled, the increase of ADR became statistically significant.…”

“…As shown from the characteristics in Table , the trials of Pontone et al . and de Leone et al . had inconsistency in volume of PEG in SIM group and in non‐SIM group, respectively.…”

“…Therefore, it is highly possible that the previous inconsistent results were because of the relatively small sample size, which affected the detection of effect of SIM on ADR during colonoscopy. Moreover, in the study conducted by de Leone et al ., another reason for inconsistent result was highly possible that the 4‐L volume of PEG for bowel preparation in non‐SIM group influenced the ADR during colonoscopy, while in SIM group, only 2‐L volume of PEG was administrated. In order to eliminate the influence of the dosage of PEG, subgroup analysis focusing on the other four trials that had the same volume of 2‐L PEG both in SIM group and non‐SIM group was conducted, and it still revealed a significant effect of SIM in the increase of ADR during colonoscopy.…”

“…In order to improve the level of bowel cleansing, simethicone (SIM), a kind of oral antifoaming agent, has been added to several PEG‐based bowel preparation regimens, for it reduces bubbles in bowel segments so as to improve visualization of the colonic mucosa and promote emission of excessive gas …”

“…Although several randomized controlled trials (RCTs) have reported that supplemental SIM can improve bowel preparation, there is no consensus as to whether it can ultimately increase the ADR during colonoscopy, which is more clinically concerned to the prevention of CRC. Two RCTs have reported the significantly high ADR in SIM group, but other several RCTs have revealed inconsistent conclusions . Thus, to date, it is still unclear whether supplemental SIM for bowel preparation could increase ADR during colonoscopy.…”