Improving Bowel Preparation for Out-Patient Flexible Sigmoidoscopy

Aim: This study aims to compare two methods of bowel preparation prior to flexible sigmoidoscopy with the current standard of a single Fleet enema.

Methods: From January-September 2003, patients were randomised as: – Group 1: One Fleet enema two hours pre-procedure; Group 2: Two Fleet enemas, one on the evening prior to sigmoidoscopy and one two hours pre-procedure; Group 3: Lactulose 30mls orally 48 and 24 hours prior to sigmoidoscopy plus a single Fleet enema two hours pre-procedure. A patient questionnaire assessed its side effects and tolerance. Endoscopists, blinded to the preparation, completed questionnaires regarding procedure indication and preparation quality (excellent/good/fair/poor).

Results: 261 patients were randomised. No difference was noted between the groups with regards age, gender, procedure indication, grade of endoscopist or any of the patient acceptability variables examined. There was no difference in the proportion of patients having acceptable bowel preparation in Group 1 vs. 2 (83%vs.88%) or Group 1 vs. 3 (83%vs.73%). However, lactulose+Fleet resulted in significantly fewer patients with acceptable preparation compared with two Fleet enemas (p=0.02).

Conclusion: The addition of a Fleet enema or oral lactulose over and above a single fleet enema gives no significant improvement in the acceptability or efficacy of bowel preparation.