Scandinavian Journal of Gastroenterology. 2015; Early Online, 1–6

ORIGINAL ARTICLE

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The use of low-volume polyethylene glycol containing ascorbic acid versus 2 L of polyethylene glycol plus bisacodyl as bowel preparation for colonoscopy

CHUNG HYUN TAE1, SUNG-AE JUNG1, SUN-KYUNG NA1, HYE-KYUNG SONG2, CHANG MO MOON1, SEONG-EUN KIM1, KI-NAM SHIM1, HYE-KYUNG JUNG1 & IL HWAN MOON1 1

Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea, and 2Department of Health Promotion Medicine, Ewha Womans University Medical Center Mokdong Hospital, Seoul, Korea

Abstract Objective. Low-volume polyethylene glycol (PEG) bowel preparations have been developed to improve compliance for colonoscopy. Our study aimed to compare the efficacy and tolerability of low-volume PEG containing ascorbic acid for colonoscopy against 2 L of PEG plus bisacodyl. Methods. We prospectively enrolled consecutive inpatients who had not undergone polypectomy at the index colonoscopy and were subsequently referred for polypectomy at our hospital. A total of 62 patients were randomized to receive either low-volume PEG containing ascorbic acid (n = 31) or 2 L of PEG plus bisacodyl (n = 31) as a split-dose regimen in inpatients. The efficacy of preparation was determined using the Ottawa Bowel Preparation Score (OBPS) and a 4-point scale. Adverse events, tolerability, and willingness were evaluated using a questionnaire. Results. Based on the OBPS and 4-point scale, we determined that the efficacy of low-volume PEG containing ascorbic acid was comparable to that of the 2 L of PEG plus bisacodyl (p = 0.071 for OBPS, p = 0.056 for the 4-point scale). Adverse events were comparable between the two groups (p = 1.000). A greater proportion of patients in the low-volume PEG containing ascorbic acid (90.6%) and the 2L of PEG plus bisacodyl (96.9%) were willing to repeat the same preparation for subsequent colonoscopy.Conclusion. Low-volume PEG containing ascorbic acid had comparable efficacy and tolerability to 2 L of PEG plus bisacodyl, when given as a split dose, for colonoscopy in inpatients. Split-dose low-volume PEG containing ascorbic acid is a good alternative for bowel preparation for colonoscopy in inpatients.

Key Words: ascorbic acid, bisacodyl, bowel preparation solutions, colonoscopy, polyethylene glycol

Introduction Although colonoscopy is considered the standard for evaluation of the colon and prevention of the development of colorectal cancer by removing adenomatous polyps, miss rate of up to 28% and 20% was reported for polyps and adenomas, respectively [1]. Several efforts have been made to improve the sensitivity of colonoscopy. One of these is ensuring thorough bowel cleansing for a high-quality standard examination. The 4 L of polyethylene glycol (PEG)

regimen is among the most commonly used bowel preparations. The efficacy and safety of standard PEG have been well established. However, poor compliance related to the large volume, salty taste, and unpleasant smell of sodium sulfate affects the quality of colonoscopy. In practice, ~5–15% of patients do not fully comply with the preparations [2]. Therefore, low-volume regimens have been used to improve patients’ compliance. Previously, our study has demonstrated that 2 L of PEG plus 20 mg of bisacodyl (PEG/B) could be as effective as standard PEG and

Correspondence: Sung-Ae Jung, Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-ku, Seoul, 158-710, Korea. Tel: +822 2650 5053. Fax: +822 2655 2076. E-mail: [email protected]

(Received 4 November 2014; revised 16 December 2014; accepted 16 December 2014) ISSN 0036-5521 print/ISSN 1502-7708 online  2015 Informa Healthcare DOI: 10.3109/00365521.2014.1000961

Scand J Gastroenterol Downloaded from informahealthcare.com by University of Sydney on 05/04/15 For personal use only.

2

C. H. Tae et al.

Patients and methods

or endoscopic submucosal dissection, all patients were hospitalized. Following a 3-day low-residue diet on the day before colonoscopy, patients were admitted for polypectomy or endoscopic submucosal dissection. Patients had an early light dinner, and before 7 pm, they took 250 ml of clear liquid without particles. In the PEG/A group, 1 L of PEG containing ascorbic acid (Coolprep; Taejoon Pharmaceuticals, Seoul, Korea) was provided at 8 pm, followed by an extra 500 ml of water. The remaining 1 L of PEG containing ascorbic acid was given 3 h before the colonoscopy examination, with an extra 500 ml of water. Both 1 L of bowel preparation solutions had to be ingested within 1 h. The PEG/B group received 20 mg of bisacodyl (Dulcolax-S; Boehringer Ingelheim, Seoul, Korea) 2 h after an early light dinner, but not solid food on the day before colonoscopy and then 1 L of sulfate-free PEG (Colyte; Taejoon Pharmaceuticals, Seoul, Korea) at 8 pm on the same day. The remaining 1 L of sulfate-free PEG was administered 3 h before the examination. All colonoscopies were scheduled for between 10 am and 2 pm.

Patients

Assessment by the patients

This prospective, randomized, controlled, singlecenter clinical study enrolled patients between September 2012 and May 2013. Enrolled patients had previously undergone screening colonoscopy, after which colorectal polyps had been diagnosed, and these patients had subsequently been referred for further polypectomy or endoscopic submucosal dissection. All colonoscopies were scheduled for hospitalization status. Patients were excluded if they had known or suspected gastrointestinal obstruction, ileus, clinically significant electrolyte abnormalities, as assessed using laboratory tests before the scheduled colonoscopy, previously significant gastrointestinal surgeries, women who were pregnant or lactating, those who were allergic to any preparation components, or those who were taking constipation medications. The protocol and informed consent were approved by Ewha Womans Institutional Review Board before study initiation (IRB number: ETC12-21A-34). Written informed consent was obtained from all participants before participation in the study.

After completing the assigned preparation but before the colonoscopy, patients were asked to complete a questionnaire comprising the following six questions related to the certain types of preparation, bowel preparation completion, tolerability, adverse events, preference and palatability: (1) PEG/A or PEG/B; (2) volume of bowel preparation solution consumed (>75%, 25–75% and

The use of low-volume polyethylene glycol containing ascorbic acid versus 2 L of polyethylene glycol plus bisacodyl as bowel preparation for colonoscopy.

Low-volume polyethylene glycol (PEG) bowel preparations have been developed to improve compliance for colonoscopy. Our study aimed to compare the effi...
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