Bowel Preparation for Colonoscopy with Sodium Phosphate Solution versus Polyethylene Glycol-Based Lavage: A Multicenter Trial

Abstract

Background: Adequate bowel preparation is essential for accurate colonoscopy. Both oral sodium phosphate (NaP) and polyethylene glycol-based lavage (PEG-ELS) are used predominantly as bowel cleansing modalities. NaP has gained popularity due to low drinking volume and lower costs. The purpose of this randomized multicenter observer blinded study was to compare three groups of cleansing (NaP, NaP + sennosides, PEG-ELS + sennosides) in reference to tolerability, acceptance, and cleanliness. Patient and Methods: 355 outpatients between 18 and 75 years were randomized into three groups (A, B, C) receiving NaP = A, NaP, and sennosides = B or PEG-ELS and sennosides = C. Gastroenterologists performing colonoscopies were blinded to the type of preparation. All patients documented tolerance and adverse events. Vital signs, premedication, completeness, discomfort, and complications were recorded. A quality score (0–4) of cleanliness was generated. Results: The three groups were similar with regard to age, sex, BMI, indication for colonoscopy, and comorbidity. Drinking volumes (L) (A = 4.33 + 1.2, B = 4.56 + 1.18, C = 4.93 + 1.71) were in favor of NaP (P = .005). Discomfort from ingested fluid was recorded in A = 39.8% (versus C: P = .015), B = 46.6% (versus C: P = .147), and C = 54.6%. Differences in tolerability and acceptance between the three groups were statistically not significant. No differences in adverse events and the cleanliness effects occurred in the three groups (P = .113). The cleanliness quality scores 0–2 were calculated in A: 77.7%, B: 86.7%, and C: 85.2%. Conclusions: These data fail to demonstrate significant differences in tolerability, acceptance, and preparation quality between the three types of bowel preparation for colonoscopy. Cleansing with NaP was not superior to PEG-ELS.

Colonic cleansing for colonoscopy: a risk to be taken seriously

“…The same study also reported vomiting in more than 15% and chest pain in more than 10% of patients older than 70. 18 Another issue to be considered as a result of this study is that of informed consent. Consent obtained by gastroenterologists is usually obtained after the preparation process, but before the procedure itself.…”

The efficacy and safety of colonoscopy preparation with oral sodium phosphate in elderly patients

“…Many agents have been used in colonoscopy preparation (13,14), and the efficacies of colon preparatory regimens have been compared in many studies (15,16). It has been demonstrated in some studies that polyethylene glycol (PEG) is a faster, more effective and better-tolerated method for cleansing the colon (1,17,18). In 2006, the Association of American Colon and Rectal Surgery (ASCRS), American Gastrointestinal Endoscopy Association (ASGE) and American Gastrointestinal and Endoscopic Surgery Association (SAGES) prepared a consensus documentary for intestinal preparation before colonoscopy (1).…”

Achieving the best bowel preparation for colonoscopy

“…However, oral administration of NaP to children has limitations because of serious adverse effects, such as electrolyte and fluid disturbances and acute kidney injury [133] . On the other hand, PEG with electrolytes solution also presents of the problems of the high volume required and its unpalatability [134][135][136][137][138][139] . Given theses problems, alternatives have been studied.…”