Korean J Gastroenterol.  2012 Jun;59(6):414-422. 10.4166/kjg.2012.59.6.414.

Comparison among Conventional 4 L Polyethylene Glycol, Split Method of 4 L Polyethylene Glycol and Combination of 2 L Polyethylene Glycol and Sodium Phosphate Solution for Colonoscopy Preparation

• Jo SY
• Kim N
• Lee JW
• Lim JH
• Choi C
• Chon I
• Kil H
• Min BY
• Byoun YS
• Lee BS
• Jang SE
• Park HK
• Jo HJ
• Shin CM
• Lee SH
• Park YS
• Hwang JH
• Kim JW
• Jeong SH
• Lee DH

• KMID: 1792846
• DOI: http://doi.org/10.4166/kjg.2012.59.6.414

Abstract

BACKGROUND/AIMS
The aim of this study was to compare polyethylene glycol (PEG) 4 L, split method of PEG 4 L and PEG 2 L plus sodium phosphate (NaP) in the aspect of bowel preparation quality, safety, patients' compliance and preference.
METHODS
Total 249 subjects were prospectively enrolled and received bowel preparation for colonoscopy from August to October in 2010; PEG 4 L (93 subjects), split method of 4 L PEG (74 subjects) and PEG 2 L plus NaP 90 mL group (82 subjects). To investigate the completion, preference for bowel preparation and safety, a questionnaire survey was conducted before colonoscopy.
RESULTS
There were no significant intergroup differences in the aspect of completion of preparation, cecal intubation time and success rate. Satisfaction and preference were higher in PEG 2 L plus NaP 90 mL and split method of 4 L PEG compared with PEG 4 L. In the aspect of the bowel preparation quality PEG 4 L showed significantly higher quality in the morning colonoscopy (p<0.001). However, in the afternoon colonoscopy PEG 2 L plus NaP 90 mL showed better result than PEG 4 L (p=0.009). Hyperphosphatemia was most frequently observed in PEG 2 L plus NaP 90 mL, but no severe adverse events occurred (p<0.001).
CONCLUSIONS
PEG 4 L showed better result than split method of 4 L PEG or PEG 2 L plus NaP 90 mL in the aspect of bowel preparation quality and safety.

Keyword

Colonoscopy; Bowel preparation solution; Polyethylene glycols; Sodium phosphate

MeSH Terms

Adult
Aged
Cathartics/adverse effects/*pharmacology
Colon/anatomy & histology/*drug effects
Colonoscopy
Female
Humans
Hyperphosphatemia/etiology
Male
Middle Aged
Patient Compliance
Phosphates/adverse effects/*pharmacology
Polyethylene Glycols/adverse effects/*pharmacology
Prospective Studies
Questionnaires
Time Factors

Figure

• 

  Fig. 1 Overall quality of bowel cleansing among conventional 4 L polyethylene glycol (PEG), split method of 4 L PEG and combination of 2 L PEG and sodium phosphate (NaP) solution group in total (A), in the morning colonoscopy (B) and in the afternoon colonoscopy (C).

• 

  Fig. 2 Segmental quality of bowel cleansing among conventional 4 L polyethylene glycol (PEG), split method of 4 L PEG and combination of 2 L PEG and sodium phosphate (NaP) solution group in total (A), in the morning colonoscopy (B) and in the afternoon colonoscopy (C).

• 

  Fig. 3 Overall quality of bowel cleansing between night and morning colonoscopy preparation in conventional 4 L polyethylene glycol (PEG) (A) and combination of 2 L PEG and sodium phosphate solution (NaP) (B).

Reference

1. Tan JJ, Tjandra JJ. Which is the optimal bowel preparation for colonoscopy - a meta-analysis. Colorectal Dis. 2006. 8:247–258.

2. DiPalma JA, Brady CE 3rd. Colon cleansing for diagnostic and surgical procedures: polyethylene glycol-electrolyte lavage solution. Am J Gastroenterol. 1989. 84:1008–1016.

3. Dipalma JA, Marshall JB. Comparison of a new sulfate-free polyethylene glycol electrolyte lavage solution versus a standard solution for colonoscopy cleansing. Gastrointest Endosc. 1990. 36:285–289.

4. Kang MJ, Jung SA, Jung JM, et al. A prospective trial comparing 4 L-polyethylene glycol with 2 L-polyethylene glycol plus bisacodyl tablets for colon preparation. Korean J Gastrointest Endosc. 2008. 37:167–173.

5. Cohen SM, Wexner SD, Binderow SR, et al. Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods. Dis Colon Rectum. 1994. 37:689–696.

6. Young CJ, Simpson RR, King DW, Lubowski DZ. Oral sodium phosphate solution is a superior colonoscopy preparation to polyethylene glycol with bisacodyl. Dis Colon Rectum. 2000. 43:1568–1571.

7. Law WL, Choi HK, Chu KW, Ho JW, Wong L. Bowel preparation for colonoscopy: a randomized controlled trial comparing polyethylene glycol solution, one dose and two doses of oral sodium phosphate solution. Asian J Surg. 2004. 27:120–124.

8. Ell C, Fischbach W, Keller R. Hintertux Study Group. A randomized, blinded, prospective trial to compare the safety and efficacy of three bowel-cleansing solutions for colonoscopy (HSG-01^*). Endoscopy. 2003. 35:300–304.

9. Martínek J, Hess J, Delarive J, et al. Cisapride does not improve precolonoscopy bowel preparation with either sodium phosphate or polyethylene glycol electrolyte lavage. Gastrointest Endosc. 2001. 54:180–185.

10. Curran MP, Plosker GL. Oral sodium phosphate solution: a review of its use as a colorectal cleanser. Drugs. 2004. 64:1697–1714.

11. Lee JW, Kim NY, Cha BH, et al. Comparison between conventional 4 L polyethylene glycol and combination of 2 L polyethylene glycol and sodium phosphate solution as colonoscopy preparation. Korean J Gastroenterol. 2010. 56:299–306.

12. Aoun E, Abdul-baki H, Azar C, et al. A randomized single-blind trial of split-dose PEG-electrolyte solution without dietary restriction compared with whole dose PEG-electrolyte solution with dietary restriction for colonoscopy preparation. Gastrointest Endosc. 2005. 62:213–218.

13. Abdul-baki H, Hashash JG, Elhajj II, et al. A randomized, controlled, double-blind trial of the adjunct use of tegaserod in whole-dose or split-dose polyethylene glycol electrolyte solution for colonoscopy preparation. Gastrointest Endosc. 2008. 68:294–300.

14. El SA, Kanafani ZA, Mourad FH, et al. A randomized single-blind trial of whole versus split-dose polyethylene glycol-electrolyte solution for colonoscopy preparation. Gastrointest Endosc. 2003. 58:36–40.

15. Park JS, Sohn CI, Hwang SJ, et al. Quality and effect of single dose versus split dose of polyethylene glycol bowel preparation for early-morning colonoscopy. Endoscopy. 2007. 39:616–619.

16. Aronchick CA, Lipshutz WH, Wright SH, DuFrayne F, Bergman G. Validation of an instrument to assess colon cleansing. Am J Gastroenterol. 1999. 94:2667.

17. Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc. 2004. 59:482–486.

18. Kim WH, Cho YJ, Park JY, Min PK, Kang JK, Park IS. Factors affecting insertion time and patient discomfort during colonoscopy. Gastrointest Endosc. 2000. 52:600–605.

19. Yoon JH, Park DI, Shin JE, et al. Comparison of bowel preparation depending on completion time of polyethylene glycol ingestion and start time of colonoscopy. Intest Res. 2010. 8:24–29.

20. Church JM. Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy-timing is the key. Dis Colon Rectum. 1998. 41:1223–1225.

21. Aronchick CA, Lipshutz WH, Wright SH, Dufrayne F, Bergman G. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. Gastrointest Endosc. 2000. 52:346–352.

22. Lieberman DA, Ghormley J, Flora K. Effect of oral sodium phosphate colon preparation on serum electrolytes in patients with normal serum creatinine. Gastrointest Endosc. 1996. 43:467–469.