Lubiprostone used with polyethylene glycol in diabetic patients enhances colonoscopy preparation quality

Grigg, Erika; Schubert, Moonkyung Cho; Hall, Joshua D.; Rahhal, Fadi; Raina, Dimple; Sridhar, Subbaramiah; Chamberlain, Sherman

doi:10.4253/wjge.v2.i7.263

Cited by 17 publications

(11 citation statements)

References 13 publications

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“…Split-dose regimen has been used in some clinical trials to minimize the inconvenience of ingesting large amounts of liquid. 7,8 The reasons for negative result of this study are unclear. 12 In addition, the anesthesiologists participating in endoscopy may oppose the use of split-dose preparation because of concerns about an increased risk of aspiration in those patients, especially if patients are fasting for #2 hours before the procedure.…”

Section: Discussionmentioning

confidence: 84%

“…[9][10][11] One of the drawbacks with split-dose regimen is the fact that it requires the patients to drink the remaining PEG solution very early in the morning, which some patients may not be willing to comply. Lubiprostone was given 4 hours before PEG in the study by Stengel and Jones, 7 but in the study by Grigg et al, 8 lubiprostone was given 1 hour before and then 1 hour after the consumption of PEG. 13 The strategy of using lower-volume PEG in conjunction with an additional laxative has been evaluated in several other trials.…”

Section: Discussionmentioning

confidence: 99%

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Lubiprostone Plus PEG Electrolytes Versus Placebo Plus PEG Electrolytes for Outpatient Colonoscopy Preparation

Sofi

Nawras

Pai

et al. 2015

American Journal of Therapeutics

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Bowel preparation using large volume of polyethylene glycol (PEG) solutions is often poorly tolerated. Therefore, there are ongoing efforts to develop an alternative bowel cleansing regimen that should be equally effective and better tolerated. The aim of this study was to assess the efficacy of lubiprostone (versus placebo) plus PEG as a bowel cleansing preparation for colonoscopy. Our study was a randomized, double-blind placebo-controlled design. Patients scheduled for screening colonoscopy were randomized 1:1 to lubiprostone (group 1) or placebo (group 2) plus 1 gallon of PEG. The primary endpoints were patient's tolerability and endoscopist's evaluation of the preparation quality. The secondary endpoint was to determine any reduction in the amount of PEG consumed in the lubiprostone group compared with the placebo group. One hundred twenty-three patients completed the study and were included in the analysis. There was no difference in overall cleanliness. The volume of PEG was similar in both the groups. The volume of PEG approached significance as a predictor of improved score for both the groups (P = 0.054). Lubiprostone plus PEG was similar to placebo plus PEG in colon cleansing and volume of PEG consumed. The volume of PEG consumed showed a trend toward improving the quality of the colon cleansing.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Lubiprostone Plus PEG Electrolytes Versus Placebo Plus PEG Electrolytes for Outpatient Colonoscopy Preparation

Sofi

Nawras

Pai

et al. 2015

American Journal of Therapeutics

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“…Regardless of the type of bowel preparation used, whether it is PEG or sodium phosphate-based, both types appear to have a similar level of bowel cleansing ability. Modifications of these two common types of bowel preparations, such as adding prokinetic agents to PEG [57,58] , or adding simethicone to sodium phosphate [59] , may provide some improvements in certain instances. However, it is recognized that factors other than the type of bowel cleansing agent used, have an equally, if not more, important role in influencing the quality of bowel preparation in patients undergoing colonoscopy.…”

Section: The Recent American Society For Gastrointestinalmentioning

confidence: 99%

Factors influencing quality of bowel preparation for colonoscopy

Romero

Mahadeva

2013

WJGE

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Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance. However, the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy. Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance, such as reduced cecal intubation rates, increased patient discomfort and lower adenoma detection. The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte, a non-absorbable solution, or aqueous sodium phosphate, a lowvolume hyperosmotic solution. Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar, although patients' compliance with these regimes may differ somewhat. Many studies have now shown that factors other than the type of bowel preparation regime used, can influence the quality of bowel preparation among adult patients undergoing colonoscopy. These factors can be broadly categorized as either patient-related or procedure-related. Studies from both Asia and the West have identified patient-related factors such as an increased age, male gender, presence of co-morbidity and socioeconomic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy. Additionally, procedure-related factors such as adherence to bowel preparation instructions, timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing. Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly, such that the quality of colonoscopy performance and delivery of service to patients can be optimised.

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“…LB is currently approved for the treatment of chronic idiopathic constipation and is generally well tolerated with an excellent side effect profile. Even long term usage has not shown clinically significant changes in electrolyte levels [ 12 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Addition of Lubiprostone to polyethylene glycol(PEG) enhances the quality & efficacy of colonoscopy preparation: a randomized, double-blind, placebo controlled trial

et al. 2016

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BackgroundAdequate bowel preparation is an essential prerequisite for complete mucosal visualization during colonoscopy. Polyethylene glycol (PEG) solutions are commonly used. However the large volume of the solution is often poorly tolerated. Addition of Lubiprostone (LB) could improve the adequacy of standard PEG preparation & reduce requirement. The aims to assess adequacy of PEG preparation with addition of single dose LB (24mcg) vs placebo and efficacy of reduced dose PEG + LB compared with full dose PEG + LB.MethodsSingle center prospective double blind randomized controlled trial. Part I: 442 patients for colonoscopy randomized to receive placebo (GrA) or single dose of LB (GrB) prior to PEG preparation. Quality of bowel preparation graded 0–9 according to Boston Bowel Preparation Scale (BBPS). BBPS-9: excellent and BBPS 0–4: repeat procedure.Part II: 146 patients randomized to receive LB + 1.5 L PEG (GrC; 75) or LB + 1 L PEG (GrD; 71). BBPS score compared with GrB (2 L PEG).ResultsPart I: 442 patients (221 GrA & 221 Gr B). LB resulted in significant improvement in total BBPS (7.44 + 0.14 vs. 6.36 + 0.16, p < 0.0001). 66.5 % Gr B vs 38 % Gr A had excellent prep; 42.5 % GrB vs 24 % GrA had adequate prep. Repeat procedure needed 9.5 % Gr B vs 16.7 % Gr A (P < 0.01).Part II: No difference in BBPS scores with lower doses (Gr C&D) compared to standard (GrB) (Mean BBPS 7.44 + 0.14 GrA,7.30 + 0.25 GrC;7.25 + 0.26 GrD;p >0.05).ConclusionSingle dose LB prior to PEG significantly enhanced bowel preparation compared to PEG alone. There was no significant difference in quality of preparation with lower doses of PEG when combined with LB.Trial registrationThe study protocol was approved by institutional review board and the trial was registered on March 22, 2011 with clinicaltrials.gov (NCT01324284).

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Lubiprostone used with polyethylene glycol in diabetic patients enhances colonoscopy preparation quality

Abstract: Use of 2-L capsules with PEG resulted in a trend towards improved colon prep over PEG alone in diabetic patients when given as a single-dose regimen.

Cited by 17 publications

References 13 publications

Lubiprostone Plus PEG Electrolytes Versus Placebo Plus PEG Electrolytes for Outpatient Colonoscopy Preparation

Lubiprostone Plus PEG Electrolytes Versus Placebo Plus PEG Electrolytes for Outpatient Colonoscopy Preparation

Factors influencing quality of bowel preparation for colonoscopy

Addition of Lubiprostone to polyethylene glycol(PEG) enhances the quality & efficacy of colonoscopy preparation: a randomized, double-blind, placebo controlled trial

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