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

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
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.

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

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Chun-Xia Li ◽  
Yan Guo ◽  
Yang-Jie Zhu ◽  
Jian-Ru Zhu ◽  
Qian-Song Xiao ◽  
...  
Keyword(s):  
Polyethylene Glycol ◽  
Bowel Preparation ◽  
Oral Solution ◽  
Physician Satisfaction ◽  
Detection Rates ◽  
Bowel Cleansing ◽  
Degree Of Satisfaction ◽  
Bowel Preparations ◽  
Colonoscopy Preparation

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.

scholarly journals Effectiveness in Bowel Cleansing and Patient Tolerability of Polyethylene Glycol versus Sodium Picosulphate in Patients Undergoing Colonoscopy

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Amit Kumar Jaiswal ◽  
Shatdal Chaudhary
Keyword(s):  
Polyethylene Glycol ◽  
Bowel Preparation ◽  
Lesion Detection ◽  
Open Label ◽  
Split Dose ◽  
Sodium Picosulphate ◽  
Bowel Cleansing ◽  
Colonic Preparation ◽  
Sodium Picosulfate ◽  
Structured Questionnaire

Introduction. Colonoscopy is considered as a gold standard investigation for screening of colorectal cancer and other lower gastrointestinal pathologies. Adequate bowel preparation is absolutely necessary for a fruitful colonoscopy. Various bowel cleansing agents are being used for his purpose. The aim of the present study was to compare the two bowel cleansing agents: a single dose of Polyethylene Glycol (PEG) solution and a split dose of Sodium Picosulfate (Na PICOSUL) tablet with regards to cleansing efficacy and tolerability among the patients scheduled for colonoscopy. Methods. It is an open-label hospital-based observational study. A total of sixty-four patients were grouped randomly into two groups of bowel cleansing agents that are PEG and Na PICOSUL during the study period between 1st December 2015 and 30th November 2016. Patients’ tolerability was evaluated using a structured questionnaire, and the bowel cleansing efficacy was evaluated using the Aronchick Bowel Preparation Scale (ABPS). Results. The group that received PEG solution was found to have better efficacy than that which received Na PICOSUL tablet (63.3% versus 29.4%, respectively, with a P value < 0.028) with excellent grade as per ABPS. The Na PICOSUL group was found better in terms of tolerability than the PEG group as nausea/vomiting was encountered significantly higher in the PEG group than in the Na PICOSUL group (43.3% versus 11.8%, respectively, with a P value < 0.01). Conclusions. Colonic preparation with a split dose of Na PICOSUL tablet was better tolerated than the evening before regimen of PEG solution. However, PEG solution was found to be more efficacious in bowel cleansing, but procedural performance and lesion detection were similar for both agents.

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

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)

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

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.

scholarly journals Bowel preparation for performing a colonoscopy: prospective randomized comparison study between a low-volume solution of polyethylene glycol and bisacodyl versus bisacodyl and a mannitol solution

2012 ◽  
Vol 49 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Manoel Carlos Vieira ◽  
Claudio Lyoiti Hashimoto ◽  
Flair José Carrilho
Keyword(s):  
Polyethylene Glycol ◽  
Vital Signs ◽  
Abdominal Distension ◽  
Similar Efficacy ◽  
Preparation Methods ◽  
Gold Standard Method ◽  
Mannitol Solution ◽  
Before And After ◽  
Glycol Solution

CONTEXT: Colonoscopy is currently the gold standard method to examine the colon, the rectum and the terminal ileum. In order to perform the colonoscopy, it is necessary to clean the bowel and use medications that are generally poorly tolerated by the patients. OBJECTIVE: Compare the tolerability, acceptability, safety and efficacy of two solutions used for intestinal preparation for a colonoscopy. METHODS: One hundred patients matched for sex and age were prospective randomized into two groups. Polyethylene glycol group received bisacodyl 10 mg plus 1 L of polyethylene glycol the night before and 1 L on the day of the exam. Mannitol group received bisacodyl 20 mg the day before and 1 L of a 10% mannitol solution on the day of the exam. The diet was the same for both groups. Tolerability and acceptability were measured using previously validated questionnaires. In terms of safety, variations in vital signs before and after the preparation were recorded, in addition to any complications. The quality of the preparation was graded based on the Boston and Ottawa scales. RESULTS: Ninety-six percent (96%) completed the study. As for tolerability, the mannitol preparation group exhibited a significantly higher frequency of nausea, vomiting, abdominal pain, and abdominal distension than polyethylene glycol group (P < 0.05). Acceptability was significantly better in polyethylene glycol group. The polyethylene glycol solution has also previously been shown to be safer than mannitol. No difference was observed in the quality of the preparation between the two preparation methods. CONCLUSIONS: The following conclusions can be made: polyethylene glycol solution had higher tolerability, acceptability, and safety than the mannitol and should be used instead of mannitol. Both preparation solutions have similar efficacy.

scholarly journals The Efficacy of Short-Duration Polyethylene Glycol plus Electrolytes for Improving Bowel Preparation of Colonoscopy in Patients with Chronic Constipation

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Naohisa Yoshida ◽  
Yoshikazu Inagaki ◽  
Kohei Fukumoto ◽  
Hiroyuki Yoriki ◽  
Yutaka Inada ◽  
...  
Keyword(s):  
Polyethylene Glycol ◽  
Adverse Events ◽  
Short Duration ◽  
Bowel Preparation ◽  
Chronic Constipation ◽  
Performance Status ◽  
Stool Consistency ◽  
Related Factors ◽  
Improvement Rate ◽  
Bowel Movements

Backgrounds and Aims. Sachets of polyethylene glycol plus electrolytes (PEG+E: Movicol: EA Pharma, Tokyo, Japan) are used for chronic constipation, and its efficacy is reported only for female and nonelderly people. Chronic constipation is one of the reasons of poor colonoscopic bowel preparation (BP). We analyzed its efficacy in improving chronic constipation and poor colonoscopic BP related to it, including male and elderly people. Materials and Methods. This multicenter retrospective study was conducted from September 2019 to September 2020 at 5 related institutions among patients ≥ 20 years old diagnosed with chronic constipation whose previous colonoscopic BP had had a fair or poor Aronchick score. Two or four sachets of PEG+E (13.7 or 27.4 g/day) were prescribed for 1 week before colonoscopy. We analyzed the rate of improvement in BP, effect-related factors, spontaneous bowel movements (SBMs), stool consistency, improvement of constipation symptoms, and adverse events. Results. We evaluated 106 cases (56 males) with an average age of 69.5 ± 9.4 years old (≤74 years old: 68 cases, ≥75 years old: 38 cases). The improvement rate of BP was 72.6%, and the insertion time and pain score also improved. A performance status of 1 or 2 was associated with poor BP. SBMs (times/week) increased from 4.0 ± 1.9 to 6.1 ± 2.6 ( p < 0.001 ). The overall improvement rates of SBMs, stool consistency, symptoms of constipation, and rate of adverse events were 58.5%, 90.6%, 59.4%, and 6.6%, respectively, showing no significant differences with regard to age or gender. Conclusions. Short-duration PEG+E was effective for improving poor BP and chronic constipation.

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

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
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.

Comparison Of Two Combination Iron Chelation Regimens, Deferiprone and Deferasirox Versus Deferiprone and Deferoxamine, In Pediatric Patients With β-Thalassemia Major

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 559-559 ◽  
Author(s):  
Mohsen Saleh Elalfy ◽  
Yasser Wali ◽  
S Tony ◽  
Ahmed Samir ◽  
Amira Adly
Keyword(s):  
Adverse Events ◽  
Iron Overload ◽  
Serum Ferritin ◽  
Cardiac Mri ◽  
Treatment Satisfaction ◽  
Short Form ◽  
Infusion Pump ◽  
Thalassemia Major ◽  
Serious Adverse Events ◽  
Patient Reported

Abstract Background Patients with severe iron overload may require a more rapid and efficient therapy for reduction in iron burden than what can be provided with chelation monotherapy. Combined chelation using deferoxamine (DFO) and deferiprone (DFP) is widely used to treat such patients, but the inconvenience of parenteral administration of DFO reduces the effectiveness of this regimen in many patients. Minimal data are available on the safety and efficacy of combined two orally active chelator agents. Aim To compare the safety, efficacy, compliance, treatment satisfaction, and quality of life (QoL) associated with two combination chelation regimens: DFP and DFO versus DFP and deferasirox (DFX). Methods This was a randomized, open-label trial registered as (NCT01511848) conducted at 2 treatment centers in patients aged 10 to 18 years with β-thalassemia major and severe iron overload (serum ferritin > 2500 μg/ L on chelation monotherapy, with 50% uptrend over the last 12 months). Patients were randomly allocated to one of two 12-month treatment regimens. All patients received DFP at a dose of 75 mg/kg/day, divided into 2 doses taken orally at 8 am and 3 pm. Those in Arm 1 additionally received DFO at a dose of 40 mg/kg/d delivered via subcutaneous infusion pump, starting at 10 pm, while those in Arm 2 additionally received a dose of DFX 20 mg/kg/d, taken orally at 10 pm. The primary efficacy endpoints were the difference between treatment groups in the change from baseline to 12 months of serum ferritin (SF) levels, liver iron concentration (LIC), and cardiac MRI. Secondary efficacy endpoints were the change from baseline to 12 months in QoL, using the Medical Outcomes Study Short Form health survey (SF-36). Serum ferritin was measured every 3 months, and liver and cardiac MRI T2* assessments were conducted every 6 months. Changes in all 3 measures were compared using 2-way ANOVA for repeated measures. The safety endpoint was the occurrence of serious adverse events during the study period. In addition, patients had complete blood count every 2 weeks, and monthly detailed clinical examinations that included blood sampling for serum creatinine, albumin/creatinine ratio, and liver function tests. Audiometric and ophthalmological assessments were conducted at baseline and 12 months. Assessments of compliance and of patient-reported outcomes (PROs) were assessed at weeks 424 and at end of study. Results A total of 96 patients were randomized. The arms were comparable with respect to baseline demographics, with a mean age of 14.9±1.8 years in Arm 1 and 15.1±1.9 years in Arm 2 (p=0.27), and with 65.2% males in Arm 1 and 66.6% males in Arm 2 (p=0.76). Forty of 46 patients (87%) in Arm 1 and 46 of 48 patients (92%) in Arm 2 completed all 12 months of treatment. Reasons for discontinuation were skin infection and pain at infusion sites in Arm 1,and decrease in SF < 1000 μg/ L in Arm 2. Efficacy findings: Table 1 shows the changes in SF, LIC, and cardiac MRI values at baseline and at completion of 1 year on therapy. Safety findings: No serious adverse events were reported during the study in either treatment group. The number of adverse effects reported was comparable in both arms. Compliance: Treatment compliance was significantly higher in Arm 2 than in Arm 1(95% vs. 80%, respectively<0.001). Satisfaction: Significantly more patients in Arm 2 than in Arm 1 reported being satisfied with treatment at both 6 months (92% vs. 64%, respectively; p<0.001) and 12 months (88% vs. 59%, respectively; p<0.001). QoL: Improvement in QoL was seen in significantly more patients in Arm 2 than in Arm 1 (85% vs. 60%, respectively; p<0.001). Conclusion Data from this randomized prospective study show that while both forms of combination therapy, DFP with DFX and DFP with DFO, were effective in reducing iron overload in multi-transfused β-thalassemia major, patients who received DFP and DFX showed a higher decline in serum ferritin, greater improvement in cardiac T2*, higher treatment satisfaction, better compliance, and more improvement in QoL than did patients who received DFP and DFO, with no increased toxicity. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Optimal intake of clear liquids during preparation for afternoon colonoscopy with low-volume polyethylene glycol plus ascorbic acid

2017 ◽  
Vol 05 (06) ◽  
pp. E416-E423 ◽  
Author(s):  
Masahiro Tajika ◽  
Tsutomu Tanaka ◽  
Makoto Ishihara ◽  
Yutaka Hirayama ◽  
Sachiyo Oonishi ◽  
...  
Keyword(s):  
Ascorbic Acid ◽  
Polyethylene Glycol ◽  
Good News ◽  
Controlled Study ◽  
Standard Regimen ◽  
Endoscopic Findings ◽  
Bowel Cleansing ◽  
The Difference ◽  
Colonoscopy Preparation ◽  
Lavage Solution

Abstract Background and study aims The standard colonoscopy preparation regimen in Japan for afternoon procedures is sequential intake of 1 L of polyethylene glycol electrolyte lavage solution containing ascorbic acid (PEG-ASC), 0.5 L of clear liquid, 0.5 L of PEG-ASC, and finally 0.25 L of clear fluids (all at a rate of 0.25 L every 15 min). However, this regimen seems poorly tolerated and complicated for many patients compared to previous regimen of polyethylene glycol electrolyte lavage solution. The aim of this study was to evaluate an alternate regimen of 0.5 L of PEG-ASC followed by 0.25 L clear liquids, repeated 3 times. Patients and methods This was a single-blinded, non-inferiority, randomized controlled study. Subjects were randomized to the standard regimen or the alternate regimen using a web-based registry system. All patients were instructed to eat a pre-packaged, low residue diet and to take sodium picosulfate hydrate the day before colonoscopy. The Boston Bowel Preparation Scale was used to evaluate bowel cleansing, and a 3-point scale was used to assess mucosal visibility. The primary endpoint was successful bowel cleansing. The acceptability, tolerability, safety, and endoscopic findings of these two regimens were secondary endpoints. Results A total of 409 patients were randomized to either the standard regimen (n = 204, males 54.0 %, mean age 65.5 years) or the alternate regimen (n = 205, 54.6 %, 65.0 years). The rates of successful bowel cleansing were 71.1 % (64.3 – 77.2 %) with the standard regimen vs. 75.1 % (68.6 – 80.9 %) with the alternate regimen (95 % lower confidence limit, for the difference = – 4.6, non-inferiority P < 0.05). No significant differences were found in tolerability, safety, and endoscopic findings. Conclusion The alternate regimen and standard regimen are clinically equivalent with respect to cleansing efficacy and acceptability, tolerability, safety, and endoscopic findings. These results are good news for patients with difficulty drinking the first liter of PEG-ASC.

Sign in / Sign up

Export Citation Format

Share Document