Split‐dose 1 L polyethylene glycol (PEG) with ascorbate is non‐inferior to split‐dose PEG with sodium picosulfate and magnesium citrate with similar tolerability: a randomized study

Abstract

Background and Aim Post‐marketing studies comparing low‐volume polyethylene glycol (PEG)‐based regimens are limited. This randomized study aimed to compare the efficacy and tolerability of a novel 1‐L low‐volume PEG‐based preparation: 1 L PEG+Asc (PEG3350, sodium ascorbate, sodium sulfate, ascorbic acid, sodium chloride, and potassium chloride) with PEG+SPMC (PEG3350, sodium chloride, potassium chloride and sodium sulfate, sodium picosulfate, magnesium oxide, citric acid, and aspartame), prior to routine colonoscopy at an Australian tertiary referral center. Methods Outpatients undergoing colonoscopy were randomized to receive either split‐dose 1 L PEG+Asc or split‐dose PEG+SPMC. Bowel preparation quality using the Boston Bowel Preparation Scale (BPPS), modified Aronchick scores, procedure time, cecal intubation, and adenoma detection rates were recorded. Patient compliance and tolerability were captured using a standardized questionnaire. Results A total of 173 patients were randomized, of whom 164 completed the study and were allocated to 1 L PEG+Asc (n = 82) or PEG+SPMC (n = 82). Non‐inferiority of 1 L PEG+Asc was demonstrated with 89% achieving successful preparation (total BPPS ≥6 and each sub‐score ≥2) compared with 85.4% in the PEG+SPMC group, resulting in an estimated difference of 3.7% (95% CI −6.6% to 13.9%). The median BBPS was non‐inferior in all colonic segments with 1 L PEG+Asc (BBPS 3 [interquartile range 2–3]) vs PEG+SPMC (BBPS 2 [interquartile range 2–3]). More 1 L PEG+Asc patients reported moderate to severe nausea (P = 0.028), but overall tolerability was similar. Conclusions The quality of bowel preparation achieved with 1 L PEG+Asc is non‐inferior to that with PEG+SPMC, with similar tolerability outcomes. Further studies are required in patients at risk of suboptimal bowel preparation.

Multi-center study of residual gastric volume and bowel preparation after the usage of 1L and 2L polyethylene glycol in Korea

“…Several studies have reported that 1L PEG is not inferior to 2L PEG or other bowel preparations. [24][25][26] Xin Y et al reported that there were no significant differences in appropriate bowel preparation rates and complication rates in a meta-analysis of randomized, controlled trials with 1L PEG and 2L PEG. [27] Instead of improving compliance and taste, 1L PEG has raised concerns regarding the risk of hypernatremia and dehydration in patients with renal dysfunction and electrolyte shifts that can lead to serious clinical consequences.…”

Determining efficacy of dynamic multimedia bowel preparation instructions versus standard instructions on adenoma detection and patient reported measures (DIGICLEAN trial): a study protocol for a multicentre, colonoscopist-blinded, randomised controlled trial

“…This study will determine whether participants who are given bowel preparation instructions through a combination of dynamic multimedia (scheduled SMS, smartphone application, video instructions and email) have better adenoma detection and patient-reported measures compared with participants who are given standard written-based instructions. The study will use ultra-low volume 1 L polyethylene glycol with ascorbic acid (PEG-ASC) as the choice of bowel preparation given its superiority in achieving adequate bowel preparation versus other large volume PEG-based regimens, and possible high patient acceptability given its low volume 20 21. The study will also identify risk factors that predict poor bowel preparation, compare procedural and clinician time required between the two groups, identify colorectal cancer risk factors and explore the potential financial implications, including in pre-anaesthetic screening.…”