Same-day 2-L PEG-citrate-simethicone plus bisacodyl vs split 4-L PEG: Bowel cleansing for late-morning colonoscopy

• Published in: World journal of gastrointestinal endoscopy 2013-09, Vol.5 (9), p.433-439
• Main Authors: de Leone, Annalisa, Tamayo, Darina, Fiori, Giancarla, Ravizza, Davide, Trovato, Cristina, De Roberto, Giuseppe, Fazzini, Linda, Dal Fante, Marco, Crosta, Cristiano
• Format: Article
• Language: English
• Subjects: Bowel; Brief; Colonoscopy; Ottawa; Polyethyleneglycol; preparation; Scale; Simethicone
• ISSN: 1948-5190; 1948-5190
• DOI: 10.4253/wjge.v5.i9.433

AIM: To evaluate the efficacy, tolerability, acceptability and feasibility of bisacodyl plus low volume polyethyleneglycol-citrate-simeticone(2-L PEG-CS) taken the same day as compared with conventional split-dose 4-L PEG for late morning colonoscopy. METHODS: Randomised, observer-blind, parallel group, comparative trial carried out in 2 centres. Out patients of both sexes, aged between 18 and 85 years, undergoing colonoscopy for diagnostic investigation, colorectal cancer screening or follow-up were eligible. The PEG-CS group received 3 bisacodyl tablets(4 tablets for patients with constipation) at bedtime and 2-L PEG-CS in the morning starting 5 h before colonoscopy. The control group received a conventional 4-L PEG formulation given as split regimen; the morning dose was taken with the same schedule of the low volume preparation. The Ottawa Bowel Preparation Scale(OBPS) score was used as the main outcome measure.RESULTS: A total of 164 subjects were enrolled and 154 completed the study; 78 in the PEG-CS group and 76 in the split 4-L PEG group. The two groups were comparable at baseline. The OBPS score in the PEG-CS group(3.09 ± 2.40) and in the PEG group(2.39 ± 2.55) were equivalent(difference +0.70; 95%CI:-0.09-1.48). This was confirmed by the rate of successful bowel cleansing in the PEG-CS group(89.7%) and in the PEG group(92.1%)(difference-2.4%; 95%CI:-11.406.70). PEG-CS was superior in terms of mucosa visibility compared to PEG(85.7% vs 72.4%, P = 0.042). There were no significant differences in caecum intubation rate, time to reach the caecum and withdrawal time between the two groups. The adenoma detection rate was similar(PEG-CS 43.6% vs PEG 44.7%). No serious adverse events occurred. No difference was found in tolerability of the bowel preparations. Compliance was equal in both groups: more than 90% of subjects drunk the whole solution. Willingness to repeat the same bowel preparations was about 90% for both regimes. CONCLUSION: Same-day PEG-CS is feasible, effective as split-dose 4-L PEG for late morning colonoscopy and does not interfere with work and daily activities the day before colonoscopy.