Document Detail

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.
MedLine Citation:
PMID:  20561621     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2010-06-19
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  72     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-02     Completed Date:  2010-11-30     Revised Date:  2011-02-02    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  313-20     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Division of Gastroenterology, Curto Hospital, Polla, Italy.
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MeSH Terms
Colonic Diseases / diagnosis*
Colonoscopy / methods*
Dose-Response Relationship, Drug
Enema / methods
Follow-Up Studies
Middle Aged
Polyethylene Glycols / administration & dosage*
Prospective Studies
Reproducibility of Results
Single-Blind Method
Surface-Active Agents / administration & dosage
Reg. No./Substance:
0/Polyethylene Glycols; 0/Surface-Active Agents
Comment In:
Endoscopy. 2011 Jan;43(1):63-6   [PMID:  21234844 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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