SPLIT-DOSE LACTULOSE WITH ADJUNCTIVE ORAL BISACODYL AND ORAL SODIUM PHOSPHATE: A PILOT STUDY OF A NOVEL BOWEL PREPARATION

Aims:

Various colonoscopic bowel preparations are in use clinically. Split-dose preparations are generally recommended for morning colonoscopies. We herein present a novel form of bowel preparation with split-dose lactulose as the backbone with oral bisacodyl and sodium phosphate, in a pilot study assessing its safety and efficacy.

Methods:

Patients were instructed to adhere to clear fluids from 2000hrs the evening before. The bowel preparation utilised oral lactulose 30 mLs and bisacodyl 5 mg at 2200hrs the evening before, followed by oral lactulose 100 mLs and oral aqueous sodium phosphate 20 mLs four hours prior to the scheduled colonoscopy. All colonoscopies were carried out during the morning session. Patients' demographics, past medical and surgical history, indication for colonoscopy, tolerability, presence of side effects, colonoscopy findings, and bowel preparation cleanliness were recorded.

Results:

This pilot study consisted of 82 patients with 41 females (50%), with a median age of 57 years (range 22 to 78). The most common indication for colonoscopy was abdominal pain (43 patients, 52.4%). 78 patients (95.1%) completed their bowel preparation, with only two patients (2.4%) suffering from side effects (vomiting). Median time to reaching the cecum was five minutes (median 3 – 25), and withdrawal time was 14 minutes (median 10 – 39). 55 patients (67.1%) and six patients (7.3%) had polyps and a malignancy detected respectively. 0 patients (0%), five patients (6.1%), 45 patients (54.9%), 32 patients (39.0%) had inadequate, poor, good, and excellent bowel preparation as per the Boston Bowel Preparation Scale.

Conclusions:

This novel split-dose bowel preparation is safe, well-tolerated, and efficacious in selected patients. It should be assessed against other established preparations in future studies.