A Randomized Prospective Trial Comparing Different Regimens of Polyethylene Glycol Solution Plus Bisacodyl in the Preparation of Patients for Colonoscopy

Abstract

Background/Aims: Colonoscopy plays an important role in the diagnosis and treatment of colon disease. However, bowel preparation for colonoscopy is often poorly tolerated, because they must drink larger volumes of bowel preparation solution. This study evaluated the use of prokinetic agent and 10 mg bisacodyl for improving the efficacy and tolerability of bowel cleansing prior to colonoscopy. Methods: A total of 153 patients who underwent colonoscopy for routine clinical indications were randomly selected for one of three preparations (Group A: 3 L polyethylene glycol (PEG) plus bisacodyl 10 mg; Group B: 2 L PEG plus bisacodyl 10 mg; Group C: 2 L PEG plus bisacodyl 10 mg and mosapride citrate 5 mg). Colonoscopists rated the efficacy of colon cleansing, blinded to the preparation methods. Quality of bowel cleansing was evaluated using a 4-point scale (1 = excellent, 2 = good, 3 = fair, and 4 = inadequate), and the primary efficacy end point was mean overall bowel-cleansing score. Symptoms were scored on a 5-point scale used. Results: Fifty-three patients were randomized to Group A, 49 to Group B, and 51 to Group C. Cecal intubation time were 6.9 ± 2.4, 8.1 ± 2.5, and 7.3 ± 2.7 minutes (P = 0.81). The mean overall cleansing scores were no difference between three groups (1.6 ± 0.65, 1.7 ± 0.77, and 1.6 ± 0.69, P = 0.78). Patient ratings of acceptability and taste were worst PEG 3 L group than other groups. The average time for completion of bowel preparation was not different. Administration of mosapride citrate prior to oral bowel preparation solution did not significantly improve overall quality of the preparation. However, mosapride citrate preparation method had lower symptom score for cramping (P < 0.05) and abdominal discomfort (P < 0.05). Conclusions: Two liter PEG solution with 10 mg bisacodyl is as effective as three liter PEG solution with 10 mg bisacodyl for cleansing the colon prior to colonoscopy. Mosapride citrate effectively decreased symptoms such as cramping and abdominal discomfort during colonoscopy preparation, although it did not improve the quality of bowel preparation.