Split-dose Bowel Preparation for Colonoscopy: 2 Liters Polyethylene Glycol with Ascorbic Acid versus Sodium Picosulfate versus Oral Sodium Phosphate Tablets

Abstract

Background/Aims: Adequate bowel preparation is an essential factor affecting the visibility of colonic mucosa and safety of related therapeutic interventions. The aim of this study was to assess the efficacy, tolerability, and safety of three bowel preparation agents -2 L polyethylene glycol with ascorbic acid (PEGA), sodium picosulfate magnesium citrate (SPMC), and oral sodium phosphate tablet (NaP)-for morning colonoscopy. Methods: Here, we analyzed the medical records of patients who had taken bowel preparation agents using the split-dose method and undergone colonoscopy in a single hospital. The efficacy of bowel preparation agents was evaluated using the Ottawa bowel preparation assessment tool. The safety and tolerability of the agents were assessed by measuring the renal function and electrolytes prior to and after the procedure as well as by assessing the self-reported questionnaire. Results: Of the 365 patients (PEGA:163, SPMC: 93, NaP: 109), 98.6% ingested more than 90% of the agents. NaP showed an inferior cleansing efficacy, and serum phosphate elevation was significantly higher in the NaP group. However, the satisfaction score was lowest in the PEGA group. Age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.92-0.99, p=0.04) and preparation agents (OR of PEGA versus NaP 5.0, 95% CI 2.28-10.97, p<0.001) (OR of SPMC versus NaP 2.73, 95% CI 1.22-6.08, p=0.01) were independently associated with bowel preparation success. Conclusions: According to our analysis, NaP showed an inferior cleansing efficacy compared with PEGA and SPMC, which may be attributed to the complex administration method and lower water intake. However, large-volume ingestion remains unsatisfactory for patients. Detailed bowel preparation instructions could enhance bowel cleansing efficacy. (Korean J Gastroenterol 2017;70:89-95)

Effectiveness of concomitant use of green tea and polyethylene glycol in bowel preparation for colonoscopy: a randomized controlled study

“…In our study, more than 2/3 patients in the control group exhibited one or more complications during the preparation, similar as it was reported [20,21]. Mounts of strategies were used by clinicians to improve compliance of the patients as low-volume PEG preparation [22,23], split-dose modification [21,24], flavors using and so on [16,25]. In our study, green tea was used as a supplement in order to investigate its potential improvement of the tolerability and compliance.…”

Comparison of Two Types of 1-L Polyethylene Glycol-ascorbic Acid as Colonoscopic Bowel Preparation: A Prospective Randomized Study

“…However, low volume agents, such as NaP, OSS, and SPMC, can cause dehydration and electrolyte imbalance, such as hyponatremia in elderly patients, 14,15 and are reported to have worse preparation quality than the PEG. [15][16][17] In contrast, the PEG solution has become the preferred bowel cleansing agent owing to its safety and efficacy. On the other hand, its large volume and poor taste can cause several adverse effects, such as abdominal fullness, nausea, vomiting, and abdominal pain, which can reduce patient compliance.…”

“…On the other hand, its large volume and poor taste can cause several adverse effects, such as abdominal fullness, nausea, vomiting, and abdominal pain, which can reduce patient compliance. 11,15,16 A PEG-ascorbic acid (PEG-Asc) formulation was developed to reduce the volume of PEG that needs to be ingested and improve the taste. In this PEG-Asc formulation, ascorbic acid was added to the existing PEG formulation.…”