Randomized, controlled trial of 2 L polyethylene glycol plus ascorbate components versus sodium phosphate for bowel cleansing prior to colonoscopy for cancer screening

Ell, Christian; Fischbach, Wolfgang; Layer, Peter; Halphen, M.

doi:10.1185/03007995.2014.960513

Cited by 8 publications

(5 citation statements)

References 45 publications

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“…Indeed, a poorly tolerated preparation is not fully ingested and may not achieve adequate cleansing, and the American Society for Gastrointestinal Endoscopy (ASGE) favors preparations associated with best patient compliance to achieve best results [92]. As patient symptoms related to the preparation are reported heterogeneously and inconsistently, we opted for willingness to repeat as a surrogate of patient tolerance, as others have done, even though tolerance and willingness to repeat are not identical [22]. Certainly, the choice of preparation and the use of adjuvants should be tailored to a given situation.…”

Section: Discussionmentioning

confidence: 99%

Do adjuvants add to the efficacy and tolerance of bowel preparations? A meta-analysis of randomized trials

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Do adjuvants add to the efficacy and tolerance of bowel preparations? A meta-analysis of randomized trials

et al. 2017

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“…In one [98], the two products were equivalent in cleansing efficacy, but PEG plus ascorbate was associated with less vomiting and more complaining about the volume and inability to complete the regimen. In the other RCT [99], in contrast, 2 L PEG plus ascorbate was associated with higher efficacy of bowel cleansing (93.4 % vs. 22.8 %,…”

Section: Low Volume Peg Plus Adjuvantsmentioning

confidence: 84%

“…The most recent of these [95], with both preparations in split-dose regimens, demonstrated similarly high overall cleansing success (93.5 % vs. 93.8 %, P = 0.72; including successful cleansing of the right colon), polyp detection rates, and ADRs, along with a higher rate of adverse events (mainly nausea) in the PEG plus ascorbate group and a higher willingness to repeat the regimen in the MCSP group (83.4 % vs. 92.1, P = 0.001). Another RCT involving 973 patients [96] After the abovementioned meta-analysis had been published, two RCTs compared 2 L PEG plus ascorbate vs. oral sodium phosphate (OSP) [98,99]. In one [98], the two products were equivalent in cleansing efficacy, but PEG plus ascorbate was associated with less vomiting and more complaining about the volume and inability to complete the regimen.…”

Section: Low Volume Peg Plus Adjuvantsmentioning

confidence: 99%

Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

et al. 2019

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Main RecommendationsESGE recommends a low fiber diet on the day preceding colonoscopy.Strong recommendation, moderate quality evidence.ESGE recommends the use of enhanced instructions for bowel preparation.Strong recommendation, moderate quality evidence.ESGE suggests adding oral simethicone to bowel preparation.Weak recommendation, moderate quality evidence.ESGE recommends split-dose bowel preparation for elective colonoscopy.Strong recommendation, high quality evidence.ESGE recommends, for patients undergoing afternoon colonoscopy, a same-day bowel preparation as an acceptable alternative to split dosing.Strong recommendation, high quality evidence.ESGE recommends to start the last dose of bowel preparation within 5 hours of colonoscopy, and to complete it at least 2 hours before the beginning of the procedure.Strong recommendation, moderate quality evidence.ESGE recommends the use of high volume or low volume PEG-based regimens as well as that of non-PEG-based agents that have been clinically validated for routine bowel preparation. In patients at risk for hydroelectrolyte disturbances, the choice of laxative should be individualized.Strong recommendation, moderate quality evidence.

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“…Importantly, inadequate colonic preparation has been associated with reduced adenoma detection rates [ 30 ]. The superiority of PEG+Asc compared with NaP, where bowel preparation was the primary outcome measure, has previously been reported [ 31 ]. The objective of this study was therefore to demonstrate that better cleansing translated into the real-life situation as better polyp detection.…”

Section: Discussionmentioning

confidence: 99%

Impact of the Quality of Bowel Cleansing on the Efficacy of Colonic Cancer Screening: A Prospective, Randomized, Blinded Study

et al. 2015

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ObjectivesEfficacy of two low volume bowel cleansing preparations, polyethylene glycol plus ascorbate (PEG+Asc) and sodium picosulfate/magnesium citrate (NaPic/MgCit), were compared for polyp and adenoma detection rate (PDR and ADR) and overall cleansing ability. Primary endpoint was PDR (the number of patients with ≥1 polypoid or flat lesion recorded by the colonoscopist).MethodsDiagnostic, surveillance or screening colonoscopy patients were enrolled into this investigator-blinded, multi-center Phase IV study and randomized 1:1 to receive PEG+Asc (administered the evening before and the morning of colonoscopy, per label) or NaPic/MgCit (administered in the morning and afternoon the day before colonoscopy, per label). The blinded colonoscopist documented any lesion and assessed cleansing quality (Harefield Cleansing Scale).ResultsOf 394 patients who completed the study, 393 (PEG+Asc, N=200; NaPic/MgCit, N=193) had a colonoscopy. Overall PDR for PEG+Asc versus NaPic/MgCit was 51.5% versus 44.0%, p=0.139. PDR and ADR on the right side of the bowel were significantly higher with PEG+Asc versus NaPic/MgCit (PDR: 56[28.0%] versus 32[16.6%], p=0.007; ADR: 42[21.0%] versus 23[11.9%], p=0.015), as was detection of flat lesions (43[21.5%] versus 25[13.0%], p=0.025). Cleansing quality was better with PEG+Asc than NaPic/MgCit (98.5% versus 57.5% considered successful cleansing). Overall, there were 132 treatment-emergent adverse events (93 versus 39 for PEG+Asc and NaPic/MgCit, respectively). These were mainly mild abdominal symptoms, all of which were reported for higher proportions of patients in the PEG+Asc than NaPic/MgCit group. Twice as many patients in the NaPic/MgCit versus the PEG+Asc group reported tolerance of cleansing solution as ‘very good’.ConclusionsCompared with NaPic/MgCit, PEG+Asc may be more efficacious for overall cleansing ability, and subsequent detection of right-sided and flat lesions. This is likely attributable to the different administration schedules of the two bowel cleansing preparations, which may positively impact the detection and prevention of colorectal cancer, thereby improving mortality rates.Trial RegistrationClinicalTrials.gov NCT01689792.

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Randomized, controlled trial of 2 L polyethylene glycol plus ascorbate components versus sodium phosphate for bowel cleansing prior to colonoscopy for cancer screening

Cited by 8 publications

References 45 publications

Do adjuvants add to the efficacy and tolerance of bowel preparations? A meta-analysis of randomized trials

Do adjuvants add to the efficacy and tolerance of bowel preparations? A meta-analysis of randomized trials

Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

Impact of the Quality of Bowel Cleansing on the Efficacy of Colonic Cancer Screening: A Prospective, Randomized, Blinded Study

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