Document Detail


Colonic preparation before colonoscopy in constipated and non-constipated patients: a randomized study.
MedLine Citation:
PMID:  23964144     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: To compare the efficacy of different doses of sodium phosphate (NaP) and polyethylenglicol (PEG) alone or with bisacodyl for colonic cleansing in constipated and non-constipated patients.
METHODS: Three hundred and forty-nine patients, older than 18 years old, with low risk for renal damage and who were scheduled for outpatient colonoscopy were randomized to receive one of the following preparations (prep): 90 mL of NaP (prep 1); 45 mL of NaP + 20 mg of bisacodyl (prep 2); 4 L of PEG (prep 3) or 2 L of PEG + 20 mg of bisacodyl (prep 4). Randomization was stratified by constipation. Patients, endoscopists, endoscopists' assistants and data analysts were blinded. A blinding challenge was performed to endoscopist in order to reassure blinding. The primary outcome was the efficacy of colonic cleansing using a previous reported scale. Secondary outcomes were tolerability, compliance, side effects, endoscopist perception about the necessity to repeat the study due to an inadequate colonic preparation and patient overall perceptions.
RESULTS: Information about the primary outcome was obtained from 324 patients (93%). There were no significant differences regarding the preparation quality among different groups in the overall analysis. Compliance was higher in the NaP preparations being even higher in half-dose with bisacodyl: 94% (prep 1), 100% (prep 2), 81% (prep 3) and 87% (prep 4) (2 vs 1, 3 and 4, P < 0.01; 1 vs 3, 4, P < 0.05). The combination of bisacodyl with NaP was associated with insomnia (P = 0.04). In non-constipated patients the preparation quality was also similar between different groups, but endoscopist appraisal about the need to repeat the study was more frequent in the half-dose PEG plus bisacodyl than in whole dose NaP preparation: 11% (prep 4) vs 2% (prep 1) (P < 0.05). Compliance in this group was also higher with the NaP preparations: 95% (prep 1), 100% (prep 2) vs 80% (prep 3) (P < 0.05). Bisacodyl was associated with abdominal pain: 13% (prep 1), 31% (prep 2), 21% (prep 3) and 29% (prep 4), (2, 4 vs 1, 2, P < 0.05). In constipated patients the combination of NaP plus bisacodyl presented higher rates of satisfactory colonic cleansing than whole those PEG: 95% (prep 2) vs 66% (prep 3) (P = 0.03). Preparations containing bisacodyl were not associated with adverse effects in constipated patients.
CONCLUSION: In non-constipated patients, compliance is higher with NaP preparations, and bisacodyl is related to adverse effects. In constipated patients NaP plus bisacodyl is the most effective preparation.
Authors:
Lisandro Pereyra; Daniel Cimmino; Carlos González Malla; Mariano Laporte; Nicolás Rotholtz; Carlos Peczan; Sandra Lencinas; Silvia Pedreira; Hugo Catalano; Luis Boerr
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  World journal of gastroenterology : WJG     Volume:  19     ISSN:  2219-2840     ISO Abbreviation:  World J. Gastroenterol.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-08-21     Completed Date:  2014-01-29     Revised Date:  2014-05-20    
Medline Journal Info:
Nlm Unique ID:  100883448     Medline TA:  World J Gastroenterol     Country:  China    
Other Details:
Languages:  eng     Pagination:  5103-10     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Ambulatory Care
Argentina
Bisacodyl / administration & dosage*,  adverse effects
Cathartics / administration & dosage*,  adverse effects
Chi-Square Distribution
Colonoscopy*
Constipation / drug therapy*,  physiopathology
Defecation / drug effects*
Double-Blind Method
Female
Humans
Male
Medication Adherence
Middle Aged
Phosphates / administration & dosage*,  adverse effects
Polyethylene Glycols / administration & dosage*,  adverse effects
Therapeutic Irrigation / adverse effects,  methods*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Cathartics; 0/Phosphates; 0/Polyethylene Glycols; 603-50-9/Bisacodyl; SE337SVY37/sodium phosphate
Comments/Corrections

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