A randomized clinical prospective trial comparing split-dose picosulfate/ magnesium citrate and polyethylene glycol for colonoscopy preparation

Abstract

Background Colonoscopy remains the gold standard for the investigation of abnormalities within the colon. However, its success is highly dependent on the quality of bowel preparation. The objective of this study was to compare the bowel preparation efficacy of picosulfate/magnesium citrate (PMC) vs polyethylene glycol (PEG) in a one-day vs two-day split dose regimen. Methods A prospective, randomized, controlled trial was conducted at the Forzani & MacPhail Colon Cancer Screening Centre in Calgary, Canada. 171 colonoscopy outpatients were randomized to split-dose PMC or PEG lavage as well as into one-day split or two-day split regimens in blocks of eight. Bowel preparation quality was recorded in a blinded manner by the endoscopist using the Ottawa Bowel Preparation Scale (OBPS) prior to washing or suctioning. The scale results were analyzed using a two-factor analysis of variance. Results 141 patients received complete colonoscopies (PMC-71; PEG-70). PEG was found to be superior to PMC (mean OBPS: 4.14 ± 2.64 vs 5.11 ± 3.44, p = 0.019), when adjusted for administration regimen, leading to significantly more adequate bowel preparations (79.7% vs 59.7%, p = 0.007). A two-day split dose was superior to a one-day split dose regimen (mean OBPS: 3.68± 2.82 vs 5.69 ± 3.06, p<0.001). Two-day split dosing also resulted in a better right colon cleanliness score (right bowel OBPS 1.27±0.11 vs 2.10±0.12 for one-day split, P<0.001). Conclusions Optimal bowel preparation was achieved with the use of PEG lavage when administered in a two-day split dose regimen. This trial is registered with ClinicalTrials.gov under identifier NCT01415687.

<p>Efficacy and Patient Tolerability of Split-Dose Sodium Picosulfate/Magnesium Citrate (SPMC) Oral Solution Compared to the Polyethylene Glycol (PEG) Solution for Bowel Preparation in Outpatient Colonoscopy: An Evidence-Based Review</p>

“…The bowel preparation validated scoring systems used are summarized in Table 2. Rostom et al 19 conducted a single-center randomized controlled trial in which 171 patients whom were scheduled for outpatient colonoscopy were randomized to either same-day or 2-day split-dose SPMC or PEG lavage. Bowel preparation quality was recorded in a blinded manner by the endoscopist using the OBPS prior to washing or suctioning.…”

Preparo intestinal com picossulfato de sódio ou polietilenoglicol para colonoscopia eletiva em pacientes adultos ambulatoriais: revisão sistemática e metanálise

“…Nenhum dos estudos incluídos comparou regimes de preparo exclusivamente no mesmo dia. Cinco estudos compararam os preparos ajustados pelo intervalo de tempo até a colonoscopia (Kao et al, 2011;Lawrance et al, 2011;Manes et al, 2013;Muñoz et al, 2018;Rostom et al, 2019) enquanto cinco estudos compararam regimes de preparo diferentes (Rex et al, 2013;Kang et al, 2014;Kim et al, 2014b;Pohl et al, 2015;Pisera et al, 2018).…”

“…O citrato de magnésio também foi utilizado separado do picossulfato de sódio em um estudo (Kao et al, 2011). resíduos, respectivamente, por mais um, dois, dois e três dias adicionais (Regev et al, 1998;Kao et al, 2011;Lawarence et al, 2011;Katz et al, 2013;Rex et al, 2013;Muñoz et al, 2018;Quaresma et al, 2018;Seo et al, 2018;Rostom et al, 2019). Os demais quatorze estudos fizeram uso de dietas com baixo teor de resíduos ou pobre em fibra por períodos que variaram de um a sete dia antes (Manes et al, 2013;Kang et al, 2014;Kim et al, 2014a;Kim et al, 2014b;Jeon et al, 2015;Kim et al, 2015;Leitao et al, 2014;Munsterman et al, 2015;Pohl et al, 2015;Yoo et al, 2015Kojecky et al, 2018Mathus-Vliegen et al, 2018;Pisera et al, 2018;Seo et al, 2018;Kojecky et al, 2019).…”

“…Harefield (Yoo et al, 2015) e escala de preparo intestinal de Ottawa (Kao et al, 2011;Lawrance et al, 2011;Rex et al, 2013Kang et al, 2014Kim et al, 2014b;Rostom et al, 2019).…”

“…Dezesseis estudos, correspondendo a dezenove comparações, demonstraram eficácia semelhante entre o PSCM e o PEG para o preparo intestinal (Regev et al, 1998;Kao et al, 2011;Lawrance et al, 2011;Katz et al, 2013;Manes et al, 2013;Kang et al, 2014;Kim et al, 2014b;Jeon et al, 2015;Kim et al, 2015;Kojecky et al, 2018;Mathus-Vliegen et al, 2018;Muñoz et al, 2018;Seo et al, 2018;Kojecky et al, 2019). Enquanto em dois estudos o PSCM foi superior ao PEG para o preparo intestinal (Rex et al, 2013;Kim et al, 2014a), em quatro o PEG foi superior ao PSCM (Pohl et al, 2015;Quaresma et al, 2018;Pisera et al, 2019;Rostom et al, 2019).…”