| Effective bowel cleansing before colonoscopy: a randomized study of split-dosage versus non-split dosage regimens of high-volume versus low-volume polyethylene glycol solutions. | |
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MedLine Citation:
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PMID: 20561621 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Adequate bowel cleansing is essential for a high-quality, effective, and safe colonoscopy. OBJECTIVES: To evaluate the degree of colon cleansing comparing split-dosage versus non-split-dosage intake of two different polyethylene glycol (PEG) volumes (low-volume PEG + ascorbic acid vs standard-volume PEG-electrolyte solution) and to identify predictors of poor bowel cleansing. DESIGN: Single-blind, active control, randomized study. SETTING: Tertiary-care institutions in Italy. PATIENTS: This study involved adult patients undergoing elective colonoscopy. INTERVENTION: Colonoscopy with different bowel preparation methods. MAIN OUTCOME MEASUREMENTS: Degree of bowel cleansing. RESULTS: We randomized 895 patients, and 868 patients were finally included in intention-to-treat (ITT) analysis. Overall compliance was excellent (97%) for both preparation methods. No difference in tolerability was recorded. Palatability was superior with low volume compared with high volume (acceptable or good 58% vs 51%, respectively, P < .005), independently of intake schedule. PEG plus ascorbic acid produced the same degree of cleansing as standard-volume PEG-electrolyte solution (77% vs 73.4%, respectively, within the split-dosage group and 41.7% vs 44.3%, respectively, within the non-split-dosage group). Independently of PEG volumes, the split-dosage regimen produced markedly superior cleansing results over the same-day method (good/excellent 327/435, 75.2% vs 186/433, 43.0%, P = .00001). Maximum cleansing was observed in colonoscopies performed within 8 hours from the last fluid intake versus over 8 hours from the last fluid intake (P < .001). The degree of bowel cleansing affected both cecal intubation (failed intubation 11.7% with fair/poor preparation vs 1.2% with good/excellent preparation, P = .00001) and polyp detection rates (12.2% with fair/poor vs 24.6% with good/excellent preparation, P = .001). Aborted procedures were significantly more frequent in the non-split-dosage arm (21.2% vs 6.9%, odds ratio [OR] 3.60 [2.29-5.77], P < .0001). Independent predictors of poor bowel cleansing were male sex (OR 1.45 [1.08-1.96], P = .014) and a non-split-dosage bowel preparation schedule (OR 2.08 [1.89-2.37], P = .0001). CONCLUSION: Low-volume PEG plus ascorbic acid is as effective as high-volume PEG-electrolyte solution but has superior palatability. A split-dosage schedule is the most effective bowel cleansing method. Colonoscopy should be performed within 8 hours of the last fluid intake. |
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Authors:
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Riccardo Marmo; Gianluca Rotondano; Giovanni Riccio; Armando Marone; Maria Antonia Bianco; Italo Stroppa; Anna Caruso; Nicola Pandolfo; Stefano Sansone; Elena Gregorio; Giuseppe D'Alvano; Nicoletta Procaccio; Pina Capo; Clelia Marmo; Livio Cipolletta |
Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial Date: 2010-06-19 |
Journal Detail:
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Title: Gastrointestinal endoscopy Volume: 72 ISSN: 1097-6779 ISO Abbreviation: Gastrointest. Endosc. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-08-02 Completed Date: 2010-11-30 Revised Date: 2011-02-02 |
Medline Journal Info:
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Nlm Unique ID: 0010505 Medline TA: Gastrointest Endosc Country: United States |
Other Details:
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Languages: eng Pagination: 313-20 Citation Subset: IM |
Copyright Information:
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Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Division of Gastroenterology, Curto Hospital, Polla, Italy. ricmarmo1@virgilio.it |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Colonic Diseases
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diagnosis* Colonoscopy / methods* Dose-Response Relationship, Drug Enema / methods Female Follow-Up Studies Humans Male Middle Aged Polyethylene Glycols / administration & dosage* Prospective Studies Reproducibility of Results Single-Blind Method Surface-Active Agents / administration & dosage |
| Chemical | |
Reg. No./Substance:
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0/Polyethylene Glycols; 0/Surface-Active Agents |
| Comments/Corrections | |
Comment In:
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Endoscopy. 2011 Jan;43(1):63-6
[PMID:
21234844
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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