Randomized trial of oral sulfate solution versus polyethylene glycol–ascorbic acid for bowel cleansing in elderly people

Abstract

Background and Aim:The efficacy and safety of the recently introduced low-volume purgatives in elderly people are not well known. Therefore, in this trial, we aimed to evaluate and compare the efficacy of two low-volume agents, oral sulfate solution (OSS) and 2-L polyethylene glycol with ascorbic acid (PEG-Asc), in elderly people. Methods: A prospective, randomized, single-blinded, multicenter, non-inferiority trial was performed at three university-affiliated hospitals in South Korea. Outpatients aged 65-80 years, who underwent elective colonoscopy, were enrolled. The primary outcome was the rate of adequate bowel preparation assessed using the Boston Bowel Preparation Scale. Results: A total of 199 subjects were randomized into the OSS (n = 99) or the 2-L PEG-Asc (n = 100) group. Of them, 189 subjects were included in the analysis of the primary outcome (OSS group 95 vs PEG-Asc group 94). The proportion of adequate bowel preparation was 89.5% (85/95) in the OSS group and 93.6% (88/94) in the 2-L PEG-Asc group. OSS was not inferior to 2-L PEG-Asc according to the prespecified non-inferiority margin of À15% (95% confidence interval for the difference, À12.1 to 3.8). Vomiting (11.6% vs 2.1%) and thirst (24.2% vs 11.7%) were more common in the OSS group than in the 2-L PEG-Asc group. Conclusions: OSS is an effective low-volume purgative that is non-inferior to 2-L PEG-Asc in elderly people. Both the low-volume agents were identified to be well tolerated and safe in the healthy elderly population.

Oral sulfate solution benefits polyp and adenoma detection during colonoscopy: Meta‐analysis of randomized controlled trials

“…Seven studies 20,44–49 blinded investigators but not participants and were therefore judged as unclear risk in performance bias except for one study, 43 which did not blind either investigators or participants. Regarding outcome assessment, five studies 20,43,45,46,49 were judged as low risk of bias because it was evaluated by ether blinded independent trained central readers or blind investigators; however, another three studies 44,47,48 did not clearly describe detailed information on outcome assessment and were therefore rated as unclear risk. For the remaining items, all RCTs were considered as low risk.…”

“…According to the results of a previous meta‐analysis, 23 OSS would increase the detection of polyps and adenomas because it significantly increased the proportion of patients with excellent bowel preparation. However, among the included six RCTs that reported primary outcomes, only one found a significantly increased PDR 20 or ADR 47 in the OSS group. The other included RCTs did not detect differences between OSS and PEG‐based regimens in terms of PDR or ADR, which were consistent with the results of a retrospective study 41 and a conference abstract 50 .…”

“…14,21,22 Additionally, we identified another eligible study 43 from published studies. Therefore, eight RCTs 20,[43][44][45][46][47][48][49] were included for final analysis (Fig. 1).…”

“…All RCTs 20,[43][44][45][46][47][48][49] were published between 2016 and 2021, and most RCTs 20,[44][45][46]49 were conducted in Korea. The sample size of all eligible RCTs ranged between 167 and 556, with a total sample size of 2059.…”

Optimizing bowel preparation for colonoscopy: A cross-sectional study of the Chinese population

“…An inadequate bowel preparation regimen is an important factor that affects the adequacy of bowel preparation. It is reported that the rate of inadequate bowel preparation ranges from 20 to 30% (6). Therefore, it is crucial to improve the preparation adequacy rate.…”