Efficacy and Acceptability of 1 Liter of Polyethylene Glycol with Ascorbic Acid vs. 2 Liters of Polyethylene Glycol Plus Mosapride and Sennoside for Colonoscopy Preparation

Abstract

BackgroundBowel preparation is an important factor for an optimal outcome of colonoscopy. Recently, polyethylene glycol (PEG) solution has been in common use for bowel cleansing for colonoscopy, but some patients are intolerant of PEG because of taste or volume. A low-volume PEG administered with ascorbic acid solution (PEG-Asc) was designed to improve tolerability, but the administration of this method is more complex than that with PEG alone. This study aimed to compare bowel cleansing efficacy, safety, and tolerability of 1 L PEG-Asc with a 2 L PEG preparation with use of sennosides and mosapride.Material/MethodsThis was a prospective, single-center, non-inferiority trial that included 112 patients (PEG-Asc group, 68; PEG group, 44). The primary endpoint was the efficacy of colon cleansing assessed by endoscopists using a validated 4-point scale according to the Aronchick scale and was verified by a blinded investigator. Acceptability, tolerability, and adenoma detection rate (ADR) of these 2 regimens were secondary endpoints.ResultsWe found no statistically significant differences between the groups in colon-cleansing efficacy or in the adenoma detection rate (ADR). Moreover, overall, patients significantly favored PEG-Asc over PEG, reflecting better acceptance of PEG-Asc. Additionally, more patients favored PEG-Asc over PEG for a hypothetical future colonoscopy.ConclusionsThe alternate 1 L PEG-Asc regimen and standard 2 L PEG regimen were clinically equivalent with respect to cleansing efficacy, safety, and ADR, and more patients favored PEG-Asc than PEG. This alternate regimen may improve patient compliance and acceptance of surveillance colonoscopy.

Efficacy of ultra‐low volume (≤1 L) bowel preparation fluids: Systematic review and meta‐analysis

“…S12 ). The pooled outcome did not change significantly for any of the fluids when excluding the studies classified as high risk of bias, 36 , 46 , 52 , 63 , 67 , 72 , 74 but for the 1L‐PEGA group, a drop from 83.0% (95% CI 74.4–90.1) to 75.3% (95% CI 73.0–77.3) was found.…”

“…Of the 43 included studies, 26 evaluated SPMC, 16 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 12 1L‐PEG with ascorbate (PEGA), 46 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 four oral sulfate solution (OSS), 61 , 69 , 70 , 71 four sodium phosphate solution (NaP), 38 , 72 , 73 , 74 two sennosides, 72 , 75 and one magnesium citrate 76 (Table 1 ).…”

“…S12). The pooled outcome did not change significantly for any of the fluids when excluding the studies classified as high risk of bias, 36,46,52,63,67,72,74…”

“…Of the 43 included studies, 26 evaluated SPMC, 16, 12 1L-PEG with ascorbate (PEGA), 46,[58][59][60][61][62][63][64][65][66][67][68] four oral sulfate solution (OSS), 61,[69][70][71] four sodium phosphate solution (NaP), 38,[72][73][74] two sennosides, 72,75 and one magnesium citrate 76 (Table 1).…”

Efficacy and tolerability of 1 L polyethylene glycol plus ascorbic acid with senna versus 2 L polyethylene glycol plus ascorbic acid for colonoscopic bowel preparation: Prospective, randomized, investigator‐blinded trial

“…Senna, one of the anthraquinone stimulant laxatives commonly used for chronic constipation, 25 is reported to be useful as a BP adjunctive agent. [26][27][28][29][30][31][32][33][34][35] However, the appropriate dose and combination of senna and BP solutions are unclear. There are few reports directly comparing sennabased regimens to the conventional standard methods, 4 L PEG or 2 L PEG-Asc.…”