2 L PEG Plus Ascorbic Acid Versus 4 L PEG Plus Simethicon for Colonoscopy Preparation

Gentile, Maurizio; Rosa, Michele De; Cestaro, Giovanni; Forestieri, Pietro

doi:10.1097/sle.0b013e31828e389d

Cited by 33 publications

(30 citation statements)

References 30 publications

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“…Twenty-one trials included analyzable bowelcleanliness outcomes (64)(65)(66)(67)(68)(69)(70)(71)(72)(74)(75)(76)79,(81)(82)(83)(84)(85)(86)88,89 ). High-volume PEG-ELS did not show a signifi cant increase in bowel cleanliness (OR, 1.03; 95% CI, 0.80-1.32).…”

Section: Polyethylene Glycol-electrolyte Lavage Solutionmentioning

confidence: 89%

“…In trials of high-volume PEG-ELS (≥3 l) compared with lowvolume PEG-ELS (<3 l), willingness to repeat bowel cleansing regimen was lower in the high-volume group (OR, 0.34; 95% CI, 0.18-0.64) ( 63,66,69,70,78,79,81,83,85 ) and higher for the split-dose group (OR, 1.76; 95% CI, 1.06-2.91; P =.03) ( 39 ). For OSS, willingness to repeat was not reported in any of the studies ( 92,93 ) .…”

Section: Peg-3350 Powdermentioning

confidence: 95%

See 1 more Smart Citation

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Johnson

Barkun

Cohen

et al. 2014

American Journal of Gastroenterology

136

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The American Journal of GASTROENTEROLOGY PRACTICE GUIDELINESColorectal cancer (CRC) is the second leading cause of cancerrelated deaths in the United States ( 1 ). Colonoscopy can prevent CRC by the detection and removal of precancerous lesions. In addition to CRC screening and surveillance, colonoscopy is used widely for the diagnostic evaluation of symptoms and other positive CRC screening tests. Regardless of indication, the success of colonoscopy is linked closely to the adequacy of preprocedure bowel cleansing.Unfortunately, up to 20-25% of all colonoscopies are reported to have an inadequate bowel preparation ( 2,3 ). Th e reasons for this range from patient-related variables such as compliance with preparation instructions and a variety of medical conditions that make bowel cleansing more diffi cult to unit-specifi c factors (eg, extended wait times aft er scheduling of colonoscopy) ( 4 ). Adverse consequences of ineff ective bowel preparation include lower adenoma detection rates, longer procedural time, lower cecal intubation rates, increased electrocautery risk, and shorter intervals between examinations ( 3,5-7 ).Bowel preparation formulations intended for precolonoscopy cleansing are assessed based on their effi cacy, safety, and tolerability. Lack of specifi c organ toxicity is considered to be a prerequisite for bowel preparations. Between cleansing effi cacy and tolerability, however, the consequences of inadequate cleansing suggest that effi cacy should be a higher priority than tolerability. Consequently, the choice of a bowel cleansing regimen should be based on cleansing effi cacy fi rst and patient tolerability second. However, effi cacy and tolerability are closely interrelated. For example, a cleansing agent that is poorly tolerated and thus not fully ingested may not achieve an adequate cleansing.Th e goals of this consensus document are to provide expert, evidence-based recommendations for clinicians to optimize colonoscopy preparation quality and patient safety. Recommendations are provided using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) scoring system, which weighs the strength of the recommendation and the quality of the evidence ( 8 ). METHODS Search StrategyComputerized medical literature searches were conducted from January 1980 (fi rst year of approval of polyethylene glycol-electrolyte lavage solution [PEG-ELS]-based preparation by the Food and Drug Administration [FDA]) up to August 2013 using MEDLINE, PubMed EMBASE, Scopus, CENTRAL, and ISI Web of knowledge. We used a highly sensitive search strategy to identify reports of randomized controlled trials ( 9 ) with a combination of medical subject headings adapted to each database and text words related to colonoscopy and gastrointestinal agents, bowel preparation, generic name, and brand name. Th e complete search terms are available in Appendix A. Recursive searches and cross-referencing also were performed using a "similar articles" function; hand searches of articles were identifi ed aft er an i...

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Section: Polyethylene Glycol-electrolyte Lavage Solutionmentioning

confidence: 89%

Section: Peg-3350 Powdermentioning

confidence: 95%

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Johnson

Barkun

Cohen

et al. 2014

American Journal of Gastroenterology

136

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“…In recent studies PEGþAsc was shown to be as tolerable 41 or more tolerable 42 than 4 L PEG preparations. Similarly, when compared with other PEG-based preparations such as 4 L PEG þ simethicone 43,44 , or 2 L PEG þ citrate þ simethicone with bisacodyl 45 , PEGþAsc had comparable acceptability and tolerability. In our study, we confirm a high acceptability for PEGþAsc, similar to the NaP group which is an essential element to ensure high population adherence within screening programs.…”

Section: Discussionmentioning

confidence: 69%

Randomized, controlled trial of 2 L polyethylene glycol plus ascorbate components versus sodium phosphate for bowel cleansing prior to colonoscopy for cancer screening

Ell

Fischbach

Layer

et al. 2014

Current Medical Research and Opinion

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PEG+Asc provided superior bowel cleansing to NaP and was well tolerated. Findings for PEG+Asc are aligned with previous similar studies; however, differences observed in NaP cleansing results, especially for the proximal colon segments, may be due to factors including: differences in demographics and population types and the use of the validated Harefield Cleansing Scale as an assessment tool combined with expert reviews, which may have resulted in conservative cleansing assessments.

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“…Two RCTs reported that willingness to repeat bowel preparation was higher with the low-volume formulation than with the 4-L PEG (73% vs 65%, P = 0.079) [29,30] . In another randomized study comparing PEG-A to 4-L PEG plus simethicone, no differences were observed in efficacy, safety or tolerance [33] . In a RCT that compared PEG-A to another new low-volume solution (PEG-citrate-simethicone), both in combination with bisacodyl [34] , the latter preparation was more effective in bowel cleansing for outpatient colonoscopy.…”

Section: Resultsmentioning

confidence: 99%

“…A study compared the quality of cleansing with patient tolerance of 2 L of PEG-ELS, ad-Parra-Blanco A et al . Best preparation for colonoscopy [29] PEG 4 L vs PEG 2 L + ascorbate 72/72 Residual stool score significantly lower with PEG 4 L Corporaal et al [30] PEG 4 L vs PEG 2 L + ascorbate 149/158 PEG + ascorbate less effective in right colon cleansing Marmo et al [31] PEG 4 L vs PEG 2 L + ascorbate 435/433 PEG + ascorbate as effective as high-volume PEG-electrolyte solution but has superior palatability Ell et al [32] PEG 4 L vs PEG 2 L + ascorbate 153/155 PEG + ascorbate same efficacy and safety, better tolerance Gentile et al [33] PEG 4 L vs PEG 2 L + ascorbate 60/60 Similar efficacy Repici et al [34] PEG 2 L + ascorbate vs PEG 2 L + citrate + bisacodyl 202/203 PEG 2 L + citrate + bisacodyl more effective for bowel cleansing Bitoun et al [35] PEG 2 L + ascorbate vs NaP 169/171 PEG + ascorbate at least as efficacious as NaP, comparable efficacy, better tolerability profile Rex et al [22] 4 L PEG SF-ELS vs NaP 68/68 NaP superior bowel cleansing, similar tolerability Renaut et al [37] MC-SP vs NaP 32/41 MC-SP better tolerated, similar cleansing effectiveness Choi et al [38] NaP vs magnesium citrate + NaP (45 mL) 79/80 Both similar effectiveness Schmidt et al [39] MC-SP vs NaP 182/190 MC-SP better tolerance, similar cleansing effectiveness Hookey et al [40] MC-SP + bisacodyl vs MC-SP vs NaP 105/109/101 MC-SP + bisacodyl better colon cleansing in the right colon compared with two other groups Tjandra et al [42] MC-SP vs NaP 120/102 NaP better cleansing Katz et al [41] MC-SP vs PEG 2 L + 10 mg bisacodyl tablets 300/303 Similar quality of cleansing Rex et al [43] PEG 2 L + bisacodyl 5 ministered either on the same day or in a split dose fashion [56,57] . There was no difference in quality (with adequate bowel prep in > 90% patients in both groups).…”

Section: A Key Factor For Optimal Preparation: Timing Of Administrationmentioning

confidence: 99%

Achieving the best bowel preparation for colonoscopy

Parra‐Blanco¹,

Ruiz²,

Álvarez-Lobos³

et al. 2014

WJG

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Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here. Core tip: Bowel preparation for colonoscopy is a central issue related to the quality of the procedure. There are different agents for bowel preparation that can be administered with different schedules. We review the most commonly used agents, as well as new agents and combinations. Moreover, certain considerations should be taken into account for special populations in order to improve safety, efficacy and tolerance. Regimens for bowel preparation in special situations are discussed, such as for pedi...

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2 L PEG Plus Ascorbic Acid Versus 4 L PEG Plus Simethicon for Colonoscopy Preparation

Abstract: According to our data, low-volume PEG+Asc has comparable efficacy, safety, and tolerability as high-volume PEG+Sim; therefore, it can be considered as a good alternative solution for bowel preparation. More improvements are necessary to achieve the target of a perfect preparation.

Cited by 33 publications

References 30 publications

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Randomized, controlled trial of 2 L polyethylene glycol plus ascorbate components versus sodium phosphate for bowel cleansing prior to colonoscopy for cancer screening

Achieving the best bowel preparation for colonoscopy

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