A prospective study of bowel preparation for colonoscopy with polyethylene glycol-electrolyte solution versus sodium phosphate in Lynch syndrome: a randomized trial

Abstract

Lynch gene carriers undergo regular surveillance colonoscopies. Polyethylene glycol-electrolyte solution (PEG) is routinely prescribed for bowel cleansing, but often poorly tolerated by patients. Sodium phosphate (NaP) may be an alternative. Prospective and random comparison of bowel preparation with PEG and NaP on colon cleansing and patients’ acceptance. Patients, who previously underwent a colonoscopy, were invited to participate and randomly assigned to either PEG or NaP. They were asked to fill in a questionnaire about preparation tolerability and future preferences. The endoscopist filled out a report about the quality of colon cleansing. 125 Patients were included in the study. Nine (7%) were excluded because of missing data. The remaining 116 patients (53 PEG and 63 NaP) were included in the analysis. Baseline characteristics did not differ between groups. Before colonoscopy 20 (38%) patients using PEG experienced the preparation almost intolerable, in contrast to 7(11%) of those using NaP (P = 0.001). Eleven patients in the PEG group and 48 in the NaP group would prefer NaP in the future. The colonoscopy was poorly tolerated in 17% of the individuals in both groups (P = 0.963). The endoscopist observed a more than 75% clean colon in 83% of patients on PEG and in 71% of patients on NaP (P = 0.076), however the coecum (P = 0.025) and ascending colon was cleaner after PEG. Lynch patients tolerated NaP better and preferred this formula for future bowel preparation. Colon cleansing was suboptimal with both treatments with a tendency towards a cleaner proximal colon with PEG.

Comparison of the Efficacy and Safety of Sodium Phosphate Tablets and Polyethylene Glycol Solution for Bowel Cleansing in Healthy Korean Adults

“…Previous studies have shown that the NaP bowel-cleansing regimen was superior to the PEG regimen in terms of tolerability and acceptance, as well as satisfaction. 17 , 28 , 29 , 30 In accordance with previous studies, our study also showed that the percentages of participants who had an overall impression (tolerability and acceptance) that taking the bowel preparation agent was "very easy" or "easy" were 84.4% (27/32) and 26.7% (8/30) in the NaP group and PEG group, respectively. In addition, patients assigned to the NaP regimen were much more satisfied than those assigned to the PEG regimen (satisfaction VAS score; NaP vs. PEG, 8.5 vs. 5.5, p <0.001).…”

“…In the overall analysis, compliance in both groups was relatively high compared to that in previous studies of bowel preparation regimen. 29 , 32 The participants in our study were thoroughly instructed on how to ingest the bowel preparation agent and its importance for a complete colonoscopy. This may have increased motivation of the participants in the study and contributed to high compliance rates in the two groups.…”

Colorectal cancer screening in Lynch syndrome: Indication, techniques and future perspectives

“…Patients should be referred to expert medical centers for high‐quality colonoscopy, performed by endoscopists reaching minimal key performance indicators (KPI) such as: (i) complete exam defined by caecum intubation, (ii) adequate bowel preparation defined by a Boston scale ≥2 per segment and (iii) complete and adapted polyp resection when required. These criteria are of major importance because they are associated with a reduced rate of post‐colonoscopy CRC 33,34 . When these quality criteria are not met, a new colonoscopy must be scheduled within the next 3 months.…”

“…These criteria are of major importance because they are associated with a reduced rate of post-colonoscopy CRC. 33,34 When these quality criteria are not met, a new colonoscopy must be scheduled within the next 3 months. Contrary to sporadic adenoma, there is no minimal adenoma detection rate requirement and its use as a KPI could be cautious as data are limited.…”