3338 A prospective study of prokinetics in peg-based bowel lavage for colonoscopy.

Abstract

Background The ideal regimen for colonoscopy preparation would be inexpensive, safe, easily administered and tolerated, and would reliably cleanse the colon of solid material. Towards this end, many institutions have modified the conventional PEG regimen by addition of prokinetic agents such as metoclopramide and cisapride. These agents promote gastric emptying and, in the case of cisapride, colonic motility which should enhance patient tolerance and compliance. One study compared PEG lavage with and without metoclopramide and found no difference in effectiveness or tolerability. A study of PEG with and without cisapride found a decrease in the volume of PEG required to achieve adequate preparation. There have not been any trials comparing metoclopramide and cisapride. Aims To compare patient tolerance and adequacy of preparation with three PEG based colonoscopy regimens, PEG alone, or PEG with metoclopramide or cisapride. Methods We enrolled 120 patients scheduled for outpatient colonoscopy. Patients were randomized to one of three regimens (Group A: PEG and cisapride, Group B: PEG alone, and Group C: PEG and metoclopramide). Prior to colonoscopy, patients completed a questionnaire using a visual analog scale (0-10) to assess interference with daily routine, abdominal pain, nausea, vomiting, and dizziness. The quality of the preparation and depth of insertion of the colonoscope were graded by the endoscopist. Results Ninety-one patients completed the study, with an even distribution of patients between groups. The groups were well matched for age and sex. Using the ANOVA with Bonferroni's correction of the post test, there was no statistically significant difference in interference with daily routine (4.5, 5.9, 4.2 for groups A, B, and C, respectively), abdominal pain (2.9, 3.8, 3.1), nausea (2.3, 3.6, 1.8) vomiting (1.2, 0.9, 0.8) and dizziness (1.2, 1.8. 1.0). In regards to adequacy of preparation and depth of insertion there was no difference between the three groups. When statistical analysis was performed using a Student's t test to compare PEG alone (Group B) with PEG and any prokinetic agent (Groups A and C combined), a statistically significant difference was noted in favor of the addition of a prokinetic agent in the severity of nausea and the depth of insertion. Conclusion Addition of any prokinetic agent slightly but significantly improves the patient's toleration of precolonoscopy preparation with PEG, and adequacy of the examination. There was a nonsignificant trend favoring metoclopramide over cisapride.