A Randomized Trial of Split Dose 3 L Polyethylene Glycol Lavage Solution, 2 L Polyethylene Glycol Lavage Combined With Castor Oil, and 1 L of Polyethylene Glycol Lavage Solution Combined With Castor Oil and Ascorbic Acid for Preparation for Colonoscopy.

Xu Tian,Hui Chen,Xiao-Ling Liu,Bing Shi,Wei-Qing Chen

doi:10.3389/fmed.2019.00158

Xu Tian, Hui Chen + Show 3 more

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https://doi.org/10.3389/fmed.2019.00158

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Abstract

Background: Castor oil (CaO) has the potential of halving the required volume of bowel preparation solution; however, no clinical trial investigated the efficacy of CaO on bowel preparation for colonoscopy in addition to polyethylene glycol (PEG).Objectives: Our aim was to evaluate efficacy and safety of lower dose PEG together with 30 mL CaO alone or plus ascorbic acid (Asc) in bowel preparation before colonoscopy.Methods: Two hundred and forty-six patients were allocated randomly to ingest 2 L PEG with 30 mL CaO, 1 L PEG with 30 mL CaO plus 5 g Asc, or 3 L PEG. We used Boston Bowel Preparation Scale (BBPS) to evaluate bowel preparation efficacy. We also determined other outcomes such as procedure time, polyp or adenoma detection rate, and adverse events (AEs).Results: Of 282 patients recruited, 36 were excluded. Groups were matched for baseline characteristics except weight (P = 0.020) and body mass index (BMI) (P = 0.003). Patient's satisfaction was higher in 2 L PEG-CaO (P = 0.016) and 1 L PEG-CaO-Asc groups (P = 0·017). Patients' compliance was 67.5, 71.4, and 80.5% in 3 L PEG, 2 L PEG-CaO, and 1 L PEG-CaO-Asc groups (P = 0.014). Adequate bowel preparation rate was 75, 78.57, and 53.66% in 3 L PEG, 2 L PEG-CaO, and 1 L PEG-CaO-Asc groups (P = 0.021). There were no differences in terms of remaining outcomes.Conclusions: Despite an increase in patients' satisfaction and compliance, 1 L PEG-CaO-Asc significantly decreased adequate bowel preparation rate. However, 2 L PEG-CaO improved the patients' satisfaction and compliance and increased adequate bowel preparation rate (Registration number, ChiCTR-IIR-17012418).

Highlights

Colorectal cancer (CRC) remains the major contributor to cancer-related morbidity and mortality [1]
Based on the findings from previous studies [19, 21], we proposed that the rate of adequate bowel preparation in 3 L polyethylene glycol (PEG), 2 L PEG with 30 mL Castor oil (CaO), and 1 L PEG with 30 mL CaO plus Asc will be 85, 90, and 95%
A total of 282 consecutive patients were screened, but 36 patients were excluded due to various reasons including declined to participate in study (22 patients), failed to complete study (11 patients), and changed the preparation regime

Summary

Introduction

Colorectal cancer (CRC) remains the major contributor to cancer-related morbidity and mortality [1]. Issued data showed an approximate 50% reduction in mortality of CRC after resection of abnormal colonic lesions were performed by colonoscopy [3, 4]. Poor quality of bowel preparation will significantly decrease the efficacy and safety of colonoscopy procedure [5]. Published data suggested that inadequate bowel preparation was directly associated with more than 40% of colonoscopy failures [6]. Inadequate bowel preparation was related to lower polyp or adenoma detection rate [7], longer operation time [8], and higher risk of procedure related complications and incomplete colonoscopy rate [9]. Castor oil (CaO) has the potential of halving the required volume of bowel preparation solution; no clinical trial investigated the efficacy of CaO on bowel preparation for colonoscopy in addition to polyethylene glycol (PEG)

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