Single blind, randomised trial of efficacy and acceptability of oral Picolax versus self administered phosphate enema in bowel preparation for flexible sigmoidoscopy screening Commentary: participants should have been told they were being randomised Commentary: opportunity for patient partnership was lost

Atkin, Wendy; Hart, Andrew; Edwards, Robert P.; Cook, Claire; Wardle, Jane; McIntyre, Peter; Aubrey, Roger; Baron, Clare; Sutton, Stephen; Cuzick, Jack; Senapati, Asha; Northover, John

doi:10.1136/bmj.320.7248.1504

Cited by 54 publications

(46 citation statements)

References 11 publications

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“…We hypothesised that one potentially simple and safe way to improve left-sided colonic preparation in non-laxative CTC was to administer a phosphate enema just prior to the examination. It is known from the endoscopic literature, for example, that phosphate enema is effective and well tolerated prior to flexible sigmoidoscopy [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of colorectal cancers arise in the rectum and distal colon, with approximately 50% arising from the rectum and rectosigmoid area, with a further 25% arising from the sigmoid colon [15]. It is known that self-administered phosphate enema prior to flexible sigmoidoscopy is effective, well tolerated and more acceptable than full bowel cleansing regimes such as sodium picosulphate [16,17].…”

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confidence: 99%

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Non-laxative CT colonography with barium-based faecal tagging: is additional phosphate enema beneficial and well tolerated?

Davis

Nisbet²,

Hare³

et al. 2011

BJR

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Objective: The purpose of this study was to investigate the efficacy and tolerance of an additional phosphate enema prior to non-laxative CT colonography (CTC). Methods: 71 patients (mean age 80 years, 28 male, 43 female) underwent non-laxative CTC following 4 oral doses of diluted 2% w/w barium sulphate. Patients were invited to self-administer a phosphate enema 2 h before CTC. An experienced observer graded the volume of retained stool (1 (nil) to 4 (.75% bowel circumference coated)), retained fluid ((1 (nil) to 4 (.50% circumference obscured)), retained stool tagging quality (1 (untagged) to 5 (>75% to 100%) tagged) and confidence a polyp >6 mm could be excluded (yes/no) for each of six colonic segments. Tolerance of the enema was assessed via questionnaire. Data were analysed between those using and not using the enema by Mann-Whitney and Fisher's exact test. 18/71 patients declined the enema. Results: There was no reduction in residual stool volume with enema use compared with non-use either overall (mean score 2.6 vs 2.7, p50.76) or in the left colon (mean 2.3 vs 2.4, p50.47). Overall tagging quality was no different (mean score 4.4 vs 4.3, p50.43). There was significantly more retained left colonic fluid post enema (mean score 1.9 vs 1.1, p,0.0001), and diagnostic confidence in excluding polyps was significantly reduced (exclusion not possible in 35% segments vs 21% without enema, p50.006). Of 53 patients, 30 (56%) found the enema straightforward to use, but 4 (8%) found it unpleasant. Conclusion: Phosphate enema use prior to non-laxative CTC leads to greater retained fluid, reducing diagnostic confidence, and is not recommended.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Non-laxative CT colonography with barium-based faecal tagging: is additional phosphate enema beneficial and well tolerated?

Davis

Nisbet²,

Hare³

et al. 2011

BJR

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“…Full laxative bowel preparation is arduous for any individual [5], but it has risks for elderly people or those with comorbidity [6,7], with adverse effects including bowel perforation [8]. MPCT colon is promoted by its advocates as a safe and well-tolerated test for colon cancer, although its sensitivity is less than other modalities.…”

Section: Discussionmentioning

confidence: 99%

Gas insufflation of minimal preparation CT of the colon reduces false-positives

Slater

North²,

Hart³

et al. 2012

BJR

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Objectives: Minimal preparation CT of the colon (MPCT colon) is used for investigation of suspected colorectal cancer in frail and/or elderly patients who would be expected to tolerate laxative bowel preparation poorly. Although it has good sensitivity for colorectal cancer it has a poor specificity. We wished to investigate whether distension of the colon with carbon dioxide alone would reduce the number of false-positives, but without making the test arduous or excessively uncomfortable. Methods: 134 patients were recruited and underwent MPCT colon with gas insufflation and antispasmodics. Results were compared with a cohort of 134 patients undergoing standard protocol MPCT colon. The numbers of false-positives were compared, as was reader confidence. All trial patients were given a questionnaire documenting their experience. Results: The number of false-positives was 15% in the control group and 5% in the trial group; this difference was statistically significant, (p50.01). Reader confidence was increased in the trial group. Patient tolerance was good, with 95% saying they would have the test again. Conclusion: Use of gas insufflation and antispasmodics reduces the false-positives from 15% to 5% without adversely affecting patient tolerance.

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“…None of these reported electrolyte imbalances in their subjects. 5,6 Although Picolax may cause hypermagnesaemia, particularly in the setting of renal failure, the acuteness and severity of hypermagnesaemia in this case suggest a pathophysiologic role of gastrointestinal GVHD. High intraluminal magnesium concentration and increased intestinal permeability in its inflamed state, we believe combined to result in a rapid rise in serum magnesium concentration.…”

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confidence: 99%