Comparison of colon-cleansing methods in preparation for colonoscopy - Comparative efficacy of solutions of mannitol, sodium picosulfate and monobasic and dibasic sodium phosphates

Abstract

PURPOSE: Colonoscopy plays an essential role in the therapeutic and diagnostic approach in various colonic pathologies, the aim of the present study was to compare three solutions and their efficacy for the bowel preparation in adult patients submitted to elective colonoscopy. METHODS: Sixty patients were randomly divided into three groups of 20 each. Each group was submitted to a bowel preparation with one of the following solutions: 10% manitol, sodium picosulphate or sodium phosphate. The parameters evaluated were: taste, tolerance, associated side effects and quality of cleansing. Postural blood pressure and pulse rate as well as serum sodium, potassium, calcium and phosphate were compared. RESULTS: Sodium phosphate and 10% manitol solutions provided superior results in terms of colon cleansing compared to sodium picosulphate solution. All serum electrolytes evaluated were significantly altered in the three groups, without important clinical signs. DISCUSSION: High levels of serum phosphate were the most striking alteration in patients prepared with sodium phosphate solution, again with no clinical signs. Variations related to blood pressure and pulse rate suggested contraction of intravascular volume, with no clinical effects. CONCLUSION: Sodium phosphate and 10% manitol solutions are equivalent in providing good quality colon cleansing, with no significant side effects that could compromise the procedure.

Double blinded randomized clinical trial to assess the effectiveness of several preparations for colonoscopy

“…1,12 Nevertheless, to be an test of excellence, the quality of the preparation is a determining factor, since patients whose preparation is regular have the effectiveness of their test affected, leading to an increase in costs and also a lower polyp detection rate. 11,12 Furthermore, solutions should be safe and e with acceptable patient tolerance. 15 Our results suggest that the ingestion of any of the four types of preparation is equally effective as for the quality of the cleansing of the colon.…”

“…7 Nevertheless, this solution is widely used in Brazil, since it is considered as a good intestinal preparation method, with the best cost and with appropriate effectiveness and safety. 1,11 Lactulose, nonabsorbable disaccharide, which undergoes bacterial action, was chosen as intestinal preparation because it is widely available, affordable costs and with effectiveness results similar to those of mannitol. 12 Lactitol, as well as lactulose, have both been used as options of intestinal preparation with good results reported by the manufacturer.…”

SAFETY OF MANNITOL USE IN BOWEL PREPARATION: a prospective assessment of intestinal methane (CH4) levels during colonoscopy after mannitol and sodium phosphate (NaP) bowel cleansing

“…In addition, only recently commercially specific colon cleansing products for colonoscopy have become available in Brazil. Several studies have reported on the use of mannitol in Brazil, demonstrating effectiveness in colon preparation, good tolerability and very low complication rates (3,11,16,17,19,24,27) . Methane production in the bowel is poorly understudied.…”

A Randomized Clinical Trial Evaluating Mannitol, Lactitol, and Polyethylene Glycol Macrogol as Oral Solutions for Colonoscopy Preparation

“…Mannitol is a polyalcohol obtained by hydrogenating fructose from sucrose. It is a commonly used osmotic laxative associated with successful colonic cleansing compared to other solutions, although it is related to adverse events in more than 10% of cases (nausea, vomiting, headache, dehydration, and hypovolemia) [14][15][16]. Polyethylene glycol (polyethylene glycol [PEG]) has a molecular weight greater than 3,000 kDa and functions as a non-absorbable osmotic agent, retaining water molecules through hydrogen bonds; it is considered a good option for bowel preparation [14,15,17].…”