Polyethylene glycol vs sodium picosulfate/magnesium citrate for colonoscopy preparation

Background and study aims: Polyethylene glycol-based electrolyte solutions (PEG-ELS) and the combination of sodium picosulfate/magnesium citrate (SPMC) are commonly used bowel preparation agents. The aim of the present study was to compare the two agents with regard to cleansing efficacy and tolerance among individuals scheduled for outpatient colonoscopy.

Materials and methods: The 368 colonoscopy outpatients at three Norwegian hospitals were randomized to bowel lavage with either PEG-ELS or SPMC. Compliance and patient tolerance were evaluated using a patient questionnaire. Bowel cleansing was evaluated using the Ottawa Bowel Preparation Quality Scale (OBPS), a validated scoring system with scores between 0 (best) and 14.

Results: There was no difference in the cleansing quality between the PEG-ELS and SPMC groups (median OBPS 5.0 in both groups). The group that received SPMC reported better overall patient tolerance than the PEG-ELS group (72.6 % vs 59.0 % reporting no or slight discomfort, P < 0.01). Compliance with the recommended total fluid intake (4 L) was better in the SPMC group than in the PEG-ELS group (94.2 % vs 81.2 % respectively, P < 0.01); moreover, the polyp detection rate was superior (34.3 % vs 23.3 %, P = 0.02).

Conclusion: PEG-ELS and SPMC are equally effective in cleansing efficacy, but SPMC was better tolerated by patients and resulted in superior patient compliance and polyp detection rate.

Clinical trial registration: NCT01624454

• References

• 1 Canard JM, Debette-Gratien M, Dumas R et al. A prospective national study on colonoscopy and sigmoidoscopy in 2000 in France. Gastroenterol Clin Biol 2005; 29: 17-22
• 2 Froehlich F, Wietlisbach V, Gonvers JJ et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc 2005; 61: 378-384
• 3 Quintero E, Castells A, Bujanda L et al. Colonoscopy vs fecal immunochemical testing in colorectal-cancer screening. NEJM 2012; 366: 697-706
• 4 Segnan N, Senore C, Andreoni B et al. Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology 2007; 132: 2304-2312
• 5 Senore C, Ederle A, Fantin A et al. Acceptability and side effects of colonoscopy and sigmoidoscopy in a screening setting. J Med Screen 2011; 18: 128-134
• 6 Ko CW, Riffle S, Shapiro JA et al. Incidence of minor complications and time lost from normal activities after screening or surveillance colonoscopy. Gastrointest Endosc 2007; 65: 648
• 7 Marschall HU, Bartels F. Life-threatening complications of nasogastric administration of polyethylene glycol-electrolyte solutions (Golytely) for bowel cleansing. Gastrointest Endosc 1998; 47: 408-410
• 8 Barkun A, Chiba N, Enns R et al. Commonly used preparations for colonoscopy: efficacy, tolerability, and safety--a Canadian Association of Gastroenterology position paper. Can J Gastroenterol 2006; 20: 699-710
• 9 Lichtenstein G. Bowel preparations for colonoscopy: a review. Am J Health Syst Pharm 2009; 66: 27-37
• 10 Clarkston WK, Tsen TN, Dies DF et al. Oral sodium phosphate vs. sulfate-free polyethylene glycol electrolyte lavage solution in outpatient preparation for colonoscopy: a prospective comparison. Gastrointest Endosc 1996; 43: 42-48
• 11 Casais MN, Rosa-Diez G, Perez S et al. Hyperphosphatemia after sodium phosphate laxatives in low risk patients: prospective study. World J Gastroenterol 2009; 15: 5960-5965
• 12 Hassan C, Bretthauer M, Kaminski MF et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45: 142-150
• 13 Rahman A, Vanner SJ, Baranchuk A et al. Serial monitoring of the physiological effects of the standard Pico-Salax(R) regimen for colon cleansing in healthy volunteers. Can J Gastroenterol 2012; 26: 424-428
• 14 Lawrance JA, Massoud TF, Creasy TS et al. Colonic preparation with Picolax: patient tolerance and approaches to fluid replacement. Clin Radiol 1994; 49: 35-37
• 15 Hookey LC, Vanner S. A review of current issues underlying colon cleansing before colonoscopy. Can J Gastroenterol 2007; 21: 105-111
• 16 Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc 2004; 59: 482-486
• 17 Voiosu T, Ratiu I, Voiosu A et al. Time for individualized colonoscopy bowel-prep regimens? A randomized controlled trial comparing sodium picosulfate and magnesium citrate vs. 4-liter split-dose polyethylene glycol. J Gastrointestin Liver Dis 2013; 22: 129-134
• 18 Seo EH, Kim TO, Park MJ et al. Optimal preparation-to-colonoscopy interval in split-dose PEG bowel preparation determines satisfactory bowel preparation quality: an observational prospective study. Gastrointest Endosc 2012; 75: 583-590
• 19 Calderwood AH, Jacobson BC. Comprehensive validation of the Boston Bowel Preparation Scale. Gastrointest Endosc 2010; 72: 686-692