Comparison of Polyethylene Glycol versus Lactulose Oral Solution for Bowel Preparation prior to Colonoscopy

Objective. This study was conducted to compare a lactulose oral solution with a polyethylene glycol (PEG) formulation for colonoscopy preparation using the following metrics: quality of cleansing, colonoscopy outcomes, patient/physician satisfaction, and patient tolerability. Methods. The enrolled patients were randomly divided into two groups and received a single 2 L dose of either PEG (PEG group) or lactulose (Lac group). The Boston Bowel Preparation Scale (BBPS) was used for assessing the cleansing quality of the bowel preparations. Patient tolerability and adverse events were obtained through the completion of questionnaires. Results. The lactulose oral solution showed superior bowel cleansing compared to PEG, as evidenced by higher BBPS scores in the Lac group for all segments of the colon (P<0.05). The detection rates of polyps and intestinal lesions in the Lac group (30.68% and 36.36%, respectively) were significantly higher than those in the PEG group (12.50% vs. 13.63%, respectively). For the degree of satisfaction, the Lac group had significantly higher scores compared to the PEG group, as evaluated by both the patients and endoscopist. PEG was associated with an increased incidence of nausea. There were no statistical differences between the groups in terms of vomiting, abdominal pain or fullness, dizziness, unfavorable palatability, dry mouth, palpitation, tinnitus, and tongue numbness. Conclusion. A single 2 L dose of a lactulose oral solution had higher efficacy, improved tolerability, and acceptable safety for bowel preparation when compared to the same volume of PEG. Thus, a lactulose oral solution may be a potential bowel-cleansing option for colonoscopy preparation.

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The Effectiveness, Tolerability, and Safety of Different 1-Day Bowel Preparation Regimens for Pediatric Colonoscopy

Gastroenterology Research and Practice ◽

10.1155/2019/3230654 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Anna Szaflarska-Popławska ◽

Dominika Tunowska ◽

Ola Sobieska-Poszwa ◽

Anna Gorecka ◽

Aneta Krogulska

Keyword(s):

Polyethylene Glycol ◽

Adverse Events ◽

Bowel Preparation ◽

Similar Efficacy ◽

Serious Adverse Events ◽

Preparation Methods ◽

Sodium Picosulphate ◽

Bowel Cleansing ◽

Patient Reported ◽

Colonoscopy Preparation

Background. Currently, there is no generally accepted universal protocol for bowel preparation before colonoscopy in children. Aim. The aim of the study was to compare three different 1-day bowel preparation methods for a pediatric elective colonoscopy in terms of their efficacy, safety, and patient-reported tolerability. Material and Methods. The study was randomized, prospective, and investigator-blinded. All children aged 10 to 18 years consecutively referred to the tertiary pediatric gastroenterology unit were enrolled. The participants were randomized to receive polyethylene glycol 3350 combined with bisacodyl (PEG-bisacodyl group), or polyethylene glycol 4000 with electrolytes (PEG-ELS group), or sodium picosulphate plus magnesium oxide plus citric acid (NaPico+MgCit group). Bowel preparation was assessed according to the Boston Bowel Preparation Scale (BBPS). For patient tolerability and acceptability, questionnaires were obtained. Results. One hundred twenty-three children were allocated to three age- and sex-matched groups. All of the patients completed colonoscopies with visualization of the cecum. There was no difference among the groups for the mean BBPS score. A total of 73 patients (59.3%) experienced minor adverse events. No serious adverse events occurred in any group. Nausea was the only symptom more frequent in the PEG-ELS group compared to the NaPico+MgCit group (p=0.04), and apathy was the only symptom more frequent in PEG-bisacodyl than in the NaPico+MgCit group (p=0.04). All of the patients were able to complete 75% or more of the study protocol, and 85.4% were able to complete the full regimen. The acceptability was the highest in the NaPico+MgCit group with respect to the patient’s grade for palatability, low volume of the solution, and willingness to repeat the same protocol. Conclusion. All bowel cleansing methods show similar efficacy. However, because of the higher tolerability and acceptability profile, the NaPico+MgCit-based regimen appears to be the most proper for colonoscopy preparation in children.

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Preparation regimen is more important than patient-related factors: a randomized trial comparing a standard bowel preparation before colonoscopy with an individualized approach

Romanian Journal of Internal Medicine ◽

10.1515/rjim-2016-0047 ◽

2017 ◽

Vol 55 (1) ◽

pp. 36-43 ◽

Cited By ~ 1

Author(s):

T. Voiosu ◽

Alina Tanţău ◽

A. Voiosu ◽

Andreea Benguş ◽

Cristina Mocanu ◽

...

Keyword(s):

Polyethylene Glycol ◽

Bowel Preparation ◽

Multivariable Analysis ◽

Standard Group ◽

Related Factors ◽

Split Dose ◽

Bowel Cleansing ◽

Significant Difference ◽

Bowel Prep

Abstract Background. Optimal bowel preparation is one of the most important factors affecting the quality of colonoscopy. Several patient-related factors are known to influence the quality of bowel cleansing but randomized trials in this area are lacking. We aimed to compare an individualized bowel prep strategy based on patient characteristics to a standard preparation regimen. Material and Methods. We conducted an endoscopist-blinded multicenter randomized control-trial. The Boston Bowel Prep Score (BBPS) was used to assess quality of bowel preparation and a 10 point visual analogue scale to assess patient comfort during bowel prep. Patients were randomised to either the standard regimens of split-dose 4L polyethylene-glycol (group A), split-dose sodium picosulphate/magnesium citrate (group B) or to either of the two depending on their responses to a 3-item questionnaire (individualized preparation, group C). Results. 185 patients were randomized during the study period and 143 patients were included in the final analysis. Patients in the individualized group had a median BBPS of 7 compared to a median of 6 in the standard group (p = 0.7). Also, there was no significant difference in patients’ comfort scores, irrespective of study group or laxative regimen. However, on multivariable analysis, a split-dose 4L polyethylene-glycol was an independent predictor for achieving a BBPS>6 (OR 3.7, 95% CI 1.4-9.8), regardless of patient-related factors. Conclusion. The choice of laxative seems to be more important than patient-related factors in predicting bowel cleansing. Comfort during bowel prep is not influenced by the type of strategy used.

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3 Liter Polyethylene Glycol is Not Inferior to The Standard Bowel Preparation in Chinese Population with Equal Efficacy: A Randomized, Controlled Trial

10.21203/rs.3.rs-770238/v1 ◽

2021 ◽

Author(s):

Peng Cheng ◽

Qing-qi Chen ◽

Ju-yuan Li ◽

Zheng Cheng ◽

Dian-hua Guo ◽

...

Keyword(s):

Polyethylene Glycol ◽

Adverse Events ◽

Bowel Preparation ◽

Chinese Population ◽

Controlled Trial ◽

Chinese Patients ◽

Procedure Time ◽

Adenoma Detection ◽

Bowel Cleansing

Abstract Background Ideal bowel cleansing regimens should be both effective and well tolerated. The European Society of Gastrointestinal Endoscopy recommends 4L Polyethylene Glycol (PEG) as the standard regimen for the bowel preparation (BP). This large volume of PEG ensures a better-quality bowel cleansing but might be poorly tolerated amongst the Chinese population given their different characteristics. The current study compared the 3L and 4L PEG with regard to their effectiveness, tolerability, and safety amongst Chinese patients to identify the better suitable bowel cleansing method for this population. Methods This study employed a prospective, observer-blinded, randomized and controlled design in a high-volume endoscopic center. Consecutive patients undergoing colonoscopy were randomly assigned (1:1) to the 3L-PEG or 4L-PEG group. The quality of bowel cleansing, procedure time, adenoma detection rate (ADR), patient tolerance, and adverse events were compared. Results A total of 330 patients were included in the study. The quality of the bowel cleansing (Boston Bowel Preparation Scale) for both the whole intestine and each segment showing no significant differences between the groups. No significant differences were present with regard to the procedure time or ADR. The incidences of adverse events such as nausea (P = 0.001) and bloating (P < 0.001)were significantly lower in the 3L-PEG group. Moreover, there was a significantly higher rate of satisfaction in 3L-PEG group than that of the 4L-PEG group (P = 0.009). Conclusions 3L-PEG bowel cleansing represents an optimal alternative to a 4L-PEG preparation for Chinese people, showing a similar efficacy and superior levels of satisfaction, acceptability, and safety amongst users. We recommend 3L PEG be the routine regimen in the clinical setting for Chinese patients. (ClinicalTrials.gov registration number: NCT03356015, registered in 29 November, 2017, https://www.clinicaltrials.gov/ct2/show/NCT03356015)

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Oral Sulfate Solution versus Polyethylene Glycol as a Single-Day Preparation for Colonoscopy: A Randomized Control Trial

Journal of Digestive Endoscopy ◽

10.1055/s-0039-3401963 ◽

2019 ◽

Vol 10 (03) ◽

pp. 174-177

Author(s):

Bhavik Bharat Shah ◽

Bubun Patel ◽

Mahesh Kumar Goenka

Keyword(s):

Polyethylene Glycol ◽

Bowel Preparation ◽

Statistical Significance ◽

Sulfate Solution ◽

Cecal Intubation ◽

Solution Versus ◽

Bowel Cleansing ◽

Cecal Intubation Time ◽

Colonoscopy Preparation ◽

To Receive

Abstract Background Colonoscopy is a principal diagnostic tool for most colonic disorders. Adequate bowel preparation is essential for proper visualization of the mucosa. The aim of this study was to compare the tolerability, efficacy, and safety profile of 1 L of oral sulfate solution (OSS) in comparison to 2 L of polyethylene glycol (PEG) solution. Methods In this single-center prospective study conducted at our institute, patients were randomly assigned to receive either OSS or PEG solutions for colonoscopy preparation. Patients enrolled in either group completed a questionnaire assessing the taste of the solution used, adverse effects, and number of stools passed. Grading of the bowel cleansing quality was done as per Boston Bowel Preparation (BBP) score. Results Total of 400 patients, with 222 patients in the PEG group and 178 patients in the OSS group, were assessed. In the PEG group, 148 (66.75%) patients were males and in the OSS group 112 (62.9%) patients were males. There was no statistical significance on comparison of the taste as “good” or “bad” in both groups. All the adverse events were mild to moderate in intensity and their frequencies were comparable for both the groups. The OSS group had better bowel preparation as per the BBP score (p = 0.021) and lesser cecal intubation time (p = 0.028). Conclusion The present study demonstrated that 1 L of OSS is better than the well-established 2 L PEG solution, in terms of bowel preparation and shorter time to cecal intubation.

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A low-volume polyethylene glycol solution was associated with an increased suboptimal bowel preparation rate but had similar recommendations for an early repeat colonoscopy, procedure times, and adenoma detection rates

PLoS ONE ◽

10.1371/journal.pone.0176265 ◽

2017 ◽

Vol 12 (4) ◽

pp. e0176265 ◽

Cited By ~ 2

Author(s):

Sam C. Hankins ◽

Bryan B. Brimhall ◽

Vineel Kankanala ◽

Gregory L. Austin

Keyword(s):

Polyethylene Glycol ◽

Bowel Preparation ◽

Detection Rates ◽

Adenoma Detection ◽

Adenoma Detection Rates ◽

Low Volume ◽

Repeat Colonoscopy ◽

Glycol Solution

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Sa1073 QUALITY OF BOWEL PREPARATION FOR COLONOSCOPY WITH PRUCALOPRIDE PLUS POLYETHYLENE GLYCOL SOLUTION: A DOUBLE BLIND PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.03.091 ◽

2019 ◽

Vol 89 (6) ◽

pp. AB164 ◽

Cited By ~ 1

Author(s):

Smith Kerdsin ◽

Chinnavat Sutthivana

Keyword(s):

Randomized Controlled Trial ◽

Polyethylene Glycol ◽

Bowel Preparation ◽

Controlled Trial ◽

Double Blind ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial ◽

Glycol Solution

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Tu1148 ADENOMA DETECTION RATES WITH 1 L NER1006 BOWEL PREPARATION EXCEED MINIMUM THRESHOLD RECOMMENDATIONS IN COLONOSCOPY SCREENING POPULATION AND NER1006 DEMONSTRATES OVERALL BOWEL CLEANSING SUCCESS REGARDLESS OF COLONOSCOPY INDICATION

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.3320 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB566

Author(s):

Phillip Schoenfeld ◽

David M. Poppers ◽

Sarah Lorenzen ◽

Prateek Sharma

Keyword(s):

Bowel Preparation ◽

Minimum Threshold ◽

Detection Rates ◽

Colonoscopy Screening ◽

Adenoma Detection ◽

Bowel Cleansing ◽

Screening Population ◽

Adenoma Detection Rates

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A Randomized Prospective Study of Bowel Preparation for Colonoscopy with Low-Dose Sodium Phosphate Tablets versus Polyethylene Glycol Electrolyte Solution

Gastroenterology Research and Practice ◽

10.1155/2014/879749 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Erina Kumagai ◽

Tomoyoshi Shibuya ◽

Masae Makino ◽

Takashi Murakami ◽

Shiori Takashima ◽

...

Keyword(s):

Polyethylene Glycol ◽

Bowel Preparation ◽

Low Dose ◽

Patient Acceptance ◽

Colon Cleansing ◽

Bowel Cleansing ◽

Secondary Endpoints ◽

Tablet Preparation ◽

Sodium Phosphates ◽

Improve Patient

Optimal bowel preparation is essential for the safety and outcome of colonoscopy. A solution containing polyethylene glycol (PEG) is often used as a bowel cleansing agent, but some patients are intolerant of PEG, and this may lead to discontinuation of colonoscopy. Sodium phosphates (NaP) tablets are designed to improve patient acceptance and compliance. The objective of this study was to compare bowel preparation efficiency and patient acceptance of a 30 NaP tablet preparation (L-NaP) and a 2 L PEG preparation. Patients were randomized into either the L-NaP or PEG group. The primary endpoint was the efficiency of colon cleansing as assessed by a validated four-point scale according to the Aronchick scale by endoscopists and was verified by blinded investigators. The secondary endpoints were patients’ tolerability and acceptance. Colon-cleansing efficiency was not significantly different between the two preparations. However, patients’ overall judgment was significantly in favor of L-NaP, reflecting better acceptance of L-NaP than PEG. Additionally, more patients favored L-NaP over PEG in a hypothetical future occasion requiring colonoscopy.

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A Prospective Randomized Controlled Trial of AJG522 versus Standard PEG + E as Bowel Preparation for Colonoscopy

BioMed Research International ◽

10.1155/2015/521756 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Toshihiko Sagawa ◽

Ken Sato ◽

Taku Tomizawa ◽

Masafumi Mizuide ◽

Hidetoshi Yasuoka ◽

...

Keyword(s):

Bowel Preparation ◽

Controlled Trial ◽

Bowel Function ◽

Liquid Volume ◽

Randomized Controlled ◽

Stimulant Laxative ◽

Bowel Cleansing ◽

Prospective Randomized Controlled Trial ◽

Bowel Preparations ◽

To Receive

Polyethylene glycol- (PEG-) based bowel preparations for colonoscopies are often poorly tolerated due to the large volumes of fluid intake required. We compared low-volume “modified” PEG + ascorbic acid (AJG522) with standard PEG with electrolytes (PEG + E) in addition to a stimulant laxative and an agent to improve bowel function for the bowel cleansing before colonoscopy to evaluate its efficacy, safety, and acceptability. Outpatients scheduled to undergo colonoscopy were randomized to receive either AJG522 or PEG + E. Bowel cleansing conditions were assessed via macroscopic fecal findings by blinded and independent investigators. A survey of the patients’ feedback regarding the preparation was conducted by questionnaire. Successful cleansing was achieved in all cases, except for 4 cases in the PEG + E group, at 3 hours after taking the preparation. The fecal properties were significantly clearer in the AJG522 group than in the PEG + E group at 2 hours after taking each preparationP=0.013. Although the total liquid volume of the bowel preparation was not reduced, the AJG522 preparation could significantly reduce the required volume of the preparationP<0.0001. Moreover, the patients in the AJG522 group had better acceptabilityP=0.010. There were no significant differences in the safety profiles between groups (UMIN000013892).

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