Comparison of Four Bowel Cleansing Agents for Colonoscopy and the Factors Affecting their Efficacy. A Prospective, Randomized Study

Background and Aims: Adequate bowel preparation is essential for successful and effective colonoscopy. Several types of cleansing agents are currently available including low-volume solutions. The aim of this study was to compare the efficacy of four different bowel cleansing agents. Methods: A single-center, prospective, randomized, and single-blind study was performed. Consecutive patients referred for colonoscopy were enrolled and randomized into one of the following types of laxatives: polyethylenglycol 4L (PEG), oral sulfate solution (OSS), 2L polyethylenglycol + ascorbate (2L-PEG/Asc), or magnesium citrate + sodium picosulfate (MCSP). The primary outcome was quality of bowel cleansing evaluated according to the Boston Bowel Preparation Scale (BBPS). Secondary outcomes were polyp detection rate (PDR) and tolerability. Results: Final analysis was performed on 431 patients. The number of patients with adequate bowel preparation (BBPS total scores ≥6 and sub scores ≥2 in each segment) was not significantly different throughout all groups (95.4% PEG; 94.6% OSS; 96.3% 2L-PEG/Asc; 96.2% MCSP; p=0.955). Excellent bowel preparation (BBPS total scores ≥ 8) was associated with younger age (p=0.007). The groups did not have significantly different PDRs (49.5% PEG; 49.1% OSS; 38% 2L-PEG/Asc; 40.4% MCSP; p=0.201). The strongest predictors of pathology identification were age and male gender. The best-tolerated solution was MCSP (palatability: p<0.001; nausea: p=0.024).

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Patient Tolerability of Bowel Preparation is Associated with Polyp Detection Rate During Colonoscopy

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.232.ewh1 ◽

2014 ◽

Vol 23 (2) ◽

pp. 135-140 ◽

Cited By ~ 5

Author(s):

Edward W. Holt ◽

Kidist K. Yimam ◽

Hanley Ma ◽

Richard E. Shaw ◽

Richard A. Sundberg ◽

...

Keyword(s):

Bowel Preparation ◽

Primary Outcome ◽

Secondary Outcome ◽

Polyp Detection ◽

Cross Sectional ◽

Quality Outcomes ◽

Negative Experience ◽

Polyp Detection Rate ◽

Patient Reported ◽

Bowel Prep

Background & Aims: A number of factors have been identified that influence the yield of screeningcolonoscopy. The perceived tolerability of bowel preparation has not been studied as a predictor of quality outcomes in colonoscopy. We aimed to characterize the association between patient-perceived tolerability of bowel preparation and polyp detection during colonoscopy.Methods: We performed a cross-sectional cohort study of 413 consecutive adult patients presenting foroutpatient colonoscopy at two outpatient endoscopy centers at our institution. We developed a standardized questionnaire to assess the patient's experience with bowel preparation. Bowel preparation quality was measured using the validated Ottawa scale and colonoscopic findings were recorded for each patient. The primary outcome was polyp detection and the secondary outcome was the quality of bowel preparation.Results: Patient-reported clarity of effluent during bowel preparation correlated poorly with Ottawa score during colonoscopy, k=0.15. Female gender was an independent risk factor for a poorly tolerated bowel prep (OR 3.93, 95% CI 2.30 - 6.72, p<0.001). Report of a poorly tolerated bowel prep was independently associated with the primary outcome, polyp detection (OR 0.39, 95% CI 0.18 - 0.84, p=0.02) and also with the secondary outcome, lower quality bowel preparation (OR 2.39, 95% CI 1.17 - 4.9, p=0.02).Conclusions: A patient-perceived negative experience with bowel preparation independently predicted both a lower quality bowel preparation and a lower rate of polyp of detection. Assessment of the tolerability of bowel preparation before colonoscopy may be a clinically useful predictor of quality outcomes during colonoscopy.

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Mo1665 POLYP DETECTION AND COLON CLEANSING EFFICACY IN YOUNGER ADULTS (<50 YR) WITH A SODIUM PICOSULFATE, MAGNESIUM OXIDE, AND CITRIC ACID BOWEL PREPARATION: SUBANALYSIS FROM A RANDOMIZED, ASSESSOR-BLINDED STUDY

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.2859 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB441-AB442

Author(s):

Carol A. Burke ◽

Gautam N. Mankaney ◽

Takara A. Scott ◽

Masakazu Ando ◽

Laura Stong ◽

...

Keyword(s):

Citric Acid ◽

Magnesium Oxide ◽

Bowel Preparation ◽

Polyp Detection ◽

Younger Adults ◽

Colon Cleansing ◽

Blinded Study ◽

Sodium Picosulfate

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The Factors Affecting Polyp Detection Rate on the Timing of Colonoscopy

Gastroenterology ◽

10.1016/s0016-5085(11)62332-9 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-563-S-564

Author(s):

Jae Hak Kim ◽

Min Keun Song ◽

Chang Wook Park ◽

Yung Suk Yoo ◽

Jun Kyu Lee ◽

...

Keyword(s):

Detection Rate ◽

Polyp Detection ◽

Factors Affecting ◽

Polyp Detection Rate

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Polyp Detection Rate during Colonoscopy Is Correlated with Quality of Bowel Preparation

The American Journal of Gastroenterology ◽

10.14309/00000434-200609001-01463 ◽

2006 ◽

Vol 101 ◽

pp. S556 ◽

Cited By ~ 4

Author(s):

Lawrence B. Cohen ◽

David Kastenberg ◽

Sandra R. Lottes ◽

William P. Forbes ◽

Edwin Carter

Keyword(s):

Bowel Preparation ◽

Detection Rate ◽

Polyp Detection ◽

Polyp Detection Rate

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A comparison of oral sulfate solution with sodium picosulfate and magnesium citrate in split doses as bowel preparation for colonoscopy

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2014.09.063 ◽

2015 ◽

Vol 81 (3) ◽

pp. 778

Author(s):

Gerald Bertiger ◽

James Bugni ◽

Morris Barocas

Keyword(s):

Bowel Preparation ◽

Sulfate Solution ◽

Magnesium Citrate ◽

Sodium Picosulfate

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Efficacy of Macrogol 4000 Plus Electrolytes in Bowel Preparation for Colonoscopy in Patients with Chronic Constipation

10.21203/rs.3.rs-677823/v1 ◽

2021 ◽

Author(s):

Ryoji Ichijima ◽

Sho Suzuki ◽

Mitsuru Esaki ◽

Tomomi Sugita ◽

Kanako Ogura ◽

...

Keyword(s):

Adverse Events ◽

Bowel Preparation ◽

Chronic Constipation ◽

Detection Rate ◽

Observation Time ◽

Insertion Time ◽

Polyp Detection ◽

Cecal Intubation ◽

Polyp Detection Rate ◽

Adenoma Detection

Abstract Background: Chronic constipation is a significant factor in poor bowel preparation for colonoscopy. Macrogol 4000 plus electrolytes (Movicol, EA Pharma, Tokyo, Japan), containing polyethylene glycol (PEG) and electrolytes, have been used recently to treat patients with constipation. However, prospective studies on the use of macrogol 4000 for bowel cleansing for colonoscopy are lacking. This study aimed to investigate the efficacy and safety of macrogol 4000 in addition to PEG administered in patients with chronic constipation.Methods: This single-center, single-arm prospective study enrolled patients with chronic constipation who were scheduled to undergo colonoscopy. The primary endpoint was the proportion of good bowel preparation assessed using the Boston Bowel Preparation Scale (BBPS) (6 or more points). The secondary endpoints were the time from when pPEG (MoviPrep, EA Pharma, Tokyo, Japan) was taken until colonoscopy could be started, amount of PEG taken, number of defecations, whether additional PEG doses were taken, and adverse events. Endoscopy-related endpoints included cecal intubation rate, insertion time, observation time, adenoma detection rate (ADR), and polyp detection rate (PDR). The tolerability of PEG and macrogol 4000 was assessed using a questionnaire.Results: Forty patients were included in the analysis. The median BBPS was 7 (range, (3–9)) and ³6 points in 37 cases (92.5%). The median time until colonoscopy can be started was 210 min (90–360 min), the median volume of PEG taken was 1500 mL (1000–2000 mL), and the median number of defecations was 7 (3-20). No adverse events were observed. Fourteen patients required an additional dose of PEG. Cecal intubation was achieved in all cases, the median insertion time was 6.0 min (range, 2.3–22 min), and the median observation time was 8.8 min (range, 4.0–16.0 min). The ADR and PDR were 60.0% and 75.0%, respectively. A greater proportion of patients rated the tolerability of macrogol 4000 as good compared with that of PEG (95.0% vs. 50.0%, p < 0.01).Conclusions: Intake of macrogol 4000 in addition to PEG is effective and safe for colonoscopy in patients with chronic constipation.

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