Comparable Efficacy of a 1-L PEG and Ascorbic Acid Solution Administered with Bisacodyl versus a 2-L PEG and Ascorbic Acid Solution for Colonoscopy Preparation: A Prospective, Randomized and Investigator-Blinded Trial.

Ji Eun Kwon,Jung Won Lee,Hyun Chae Jung,Su Hwan Kim,Jong Pil Im,Seong-Joon Koh,Byeong Gwan Kim,Sang Gyun Kim,Joo Sung Kim,Kook Lae Lee,Ji Won Kim,John Green

doi:10.1371/journal.pone.0162051

Ji Eun Kwon, Jung Won Lee + Show 10 more

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https://doi.org/10.1371/journal.pone.0162051

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Abstract

BackgroundTwo liters of polyethylene glycol (PEG) solution administered with ascorbic acid (Asc) can provide efficacy similar to that of a 4-L PEG solution for colonoscopy preparation. In addition, oral bisacodyl (Bis) has been shown to reduce the volume of PEG needed for a bowel preparation with comparable efficacy. This study aimed to compare the efficacy, tolerability and safety of a 2-L PEG solution mixed with Asc versus the combination of Bis, Asc and a 1-L PEG solution.MethodsThis was a prospective, randomized, multi-centre, single-blind, non-inferiority trial. Participants who were scheduled for colonoscopy were included and randomized to receive either 2-L PEG and Asc (2L PEG/Asc group) or 1-L PEG, Asc and 20 mg Bis (1L PEG/Asc + Bis group). The quality of bowel preparation was assessed using the Boston Bowel Preparation Scale. Data regarding tolerance, compliance and adverse events were also gathered.ResultsA total of 187 participants were analyzed; 96 were allocated to the 2L PEG/Asc group and 91 to the 1L PEG/Asc + Bis group. Bowel preparation was adequate in 87.5% (84/96) of patients in the 2L PEG/Asc group and 94.5% of the 1L PEG/Asc + Bis group (86/91, p = 0.10). There was no significant difference between the two groups with respect to compliance, tolerability or safety. The patients allocated to the 1L PEG/Asc + Bis group expressed more willingness to repeat the procedure than patients in the 2L PEG/Asc group (p = 0.01).ConclusionsBowel preparation with Bis and a 1-L PEG/Asc solution is as effective, well-tolerated, and safe as a 2-L PEG/Asc solution.Trial RegistrationClinicalTrials.gov NCT 01745835; Clinical Research Information Service (CRiS) KCT0000708

Highlights

Appropriate bowel preparation is critical for the efficacy of colonoscopy.[1,2] If bowel cleansing is inadequate, polyps can be missed, the electrocautery risk increases, scope insertion becomes difficult, the examination takes longer, and the whole procedure may need to be repeated sooner.[3,4,5,6,7,8,9] Conventional bowel preparation using a 4-L polyethylene glycol (PEG) solution has been established as standard method and has proven efficacy and safety
Participants who were scheduled for colonoscopy were included and randomized to receive either 2-L PEG and Asc (2L PEG solution containing Asc (PEG/Asc) group) or 1-L PEG, Asc and 20 mg Bis (1L PEG/Asc + Bis group)
We found that there was no difference in the adequacy of bowel preparation with use of a 1L PEG/Asc + Bis or a 2L PEG/Asc preparation

Summary

Background

Two liters of polyethylene glycol (PEG) solution administered with ascorbic acid (Asc) can provide efficacy similar to that of a 4-L PEG solution for colonoscopy preparation. Oral bisacodyl (Bis) has been shown to reduce the volume of PEG needed for a bowel preparation with comparable efficacy. This study aimed to compare the efficacy, tolerability and safety of a 2-L PEG solution mixed with Asc versus the combination of Bis, Asc and a 1-L PEG solution

Methods

Results

Introduction

Study Design and Population

Discussion