Systematic review and meta-analysis: sodium picosulfate/magnesium citrate vs. polyethylene glycol for colonoscopy preparation

Zheng, Jin; Lü, Yi; Zhou, Yi; Gong, Biao

doi:10.1007/s00228-016-2013-5

Cited by 55 publications

(39 citation statements)

References 41 publications

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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. Splitting the dose of either PEG or SPMC is preferred by patients and increases the quality of the bowel preparation compared with day‐before regimens 12, 27.…”

Section: Discussionmentioning

confidence: 90%

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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Section: Discussionmentioning

confidence: 90%

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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“…Because intestinal cleanliness is the foundation of ADR, even the best new foundation must be achieved with good intestinal cleanliness [16,17]. In the choice of intestinal cleansers, polyethylene glycol is still the most widely used at home and abroad [18], and recent metaanalysis shows sodium picosulfate/magnesium citrate with better tolerability and less frequent adverse events demonstrated non-inferior bowel cleaning efficacy than that of the polyethylene glycol [19]. In addition to active oral intestinal laxative preparations, in recent years, passive intestinal cleaning methods such as Aquanet EC-2000 have also been developed, with effects similar to oral sodium matrine sulfate and mannitol oral solutions [20,21].…”

Section: Discussionmentioning

confidence: 99%

Correlation of Cleanliness among Different Bowel Segments during Colonoscopy: A Retrospective Study

Zhou

Zhang

Yang

2020

Gastroenterology Research and Practice

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Objective. To analyze the correlation of intestinal cleanliness in each segment of the Boston Intestinal Preparation Scale. Methods. From February 2017 to October 2019, the data of patients who underwent colonoscopy in the Department of Gastroenterology, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, were collected. Statistical analysis was performed according to the Boston Intestinal Preparation Scale score, and the correlation of intestinal cleanliness in each region was obtained. Results. A total of 1739 patients were included. The overall score of BBPS was 6.77±1.88. The scores of each region were 2.04±0.84 (right lateral colon), 2.25±0.68 (transverse colon), and 2.48±0.64 (left colon). The difference between the regions was statistically significant (P<0.05). The bowel cleanliness showed a gradual deterioration trend, and there was a positive correlation between colon cleanliness in each region. The accuracy of the transverse colon in predicting the right colon (AUC=0.809) is higher than that of the left colon (AUC=0.735), and the accuracy of predicting the cleanliness of the right colon intestinal tract by the cleanliness of the left colon intestinal tract is relatively low. Conclusion. Intestinal cleanliness gradually deteriorates from the direction of the insert. It is not reliable to predict the right side of poor cleanliness by using the left colon intestinal cleanliness (BBPS 0-1 score). It should continue to further endoscopy. When the cleanliness of the transverse colon is poor, then stopping further endoscopy is considered.

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“…However, these guidelines recommend that the SPMC preparation should be used cautiously in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency as ascorbic acid may provoke hemolysis in these patients. In a systematic review and meta-analysis comparing different regimens, including split-dose regimens of SPMC and PEG for colonoscopy preparation, Jin et al 35 analyzed a total of 25 RCTs and observed that no difference was found in polyp detection rate (RR=0.94; 95% CI=0.82-1.08, P=0.37; I 2 =46%) nor adenoma detection rate (RR=0.88; 95% CI=0.74-1.05, P=0.16; I 2 =37%). However, adverse events, such as nausea, vomiting, and bloating, were less frequent in the SPMC group (RR=0.78, 95% CI=0.66-0.93, P=0.004; I 2 =88%).…”

Section: Discussionmentioning

confidence: 99%

<p>Efficacy and Patient Tolerability of Split-Dose Sodium Picosulfate/Magnesium Citrate (SPMC) Oral Solution Compared to the Polyethylene Glycol (PEG) Solution for Bowel Preparation in Outpatient Colonoscopy: An Evidence-Based Review</p>

Neto

Hathorn

Tustumi

et al. 2020

CEG

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Background: Colonoscopy is the gold standard exam for evaluation of colonic abnormalities and for screening and surveillance for colorectal cancer. However, the efficacy of colonoscopy is dependent on the quality of the pre-colonoscopy bowel preparation. Polyethylene glycol (PEG) and sodium picosulfate/magnesium citrate (SPMC) have emerged as two of the most commonly used bowel preparation agents. We conducted an evidencebased review of current evidence to further investigate the efficacy and patient tolerability of split-dose SPMC oral solution compared to PEG solution for colonoscopy bowel preparation. Methods: A systematic search was performed using Pubmed (MEDLINE), Web of Science, EMBASE, and Cochran Central Register of Controlled Trials databases. All studies on splitdose bowel preparation with SPMC and PEG were reviewed. Relevant studies regarding colonoscopy and bowel preparations were also included. Randomized controlled trials were prioritized due to the high quality of evidence. Results: Eight randomized controlled trials were included. Split-dose SPMC and PEG were associated with similar results for adequacy of bowel preparation. Split-dose SPMC was associated with increased patient tolerability and compliance. Conclusion: Split-dose SPMC and PEG are both adequate and safe for bowel preparation for outpatient colonoscopy, with split-dose SPMC being more tolerable for patients. Additional RCTs comparing these and other bowel preparation solutions are necessary to further investigate quality of bowel preparation, patient preference, and cost-effectiveness of the various options.

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Systematic review and meta-analysis: sodium picosulfate/magnesium citrate vs. polyethylene glycol for colonoscopy preparation

Abstract: SPMC, with better tolerability and less frequent adverse events, demonstrated non-inferior bowel cleaning efficacy than that of the PEG. Large-scale, well-organized, head-to-head studies are warranted.

Cited by 55 publications

References 41 publications

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

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

Correlation of Cleanliness among Different Bowel Segments during Colonoscopy: A Retrospective Study

<p>Efficacy and Patient Tolerability of Split-Dose Sodium Picosulfate/Magnesium Citrate (SPMC) Oral Solution Compared to the Polyethylene Glycol (PEG) Solution for Bowel Preparation in Outpatient Colonoscopy: An Evidence-Based Review</p>

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