Abstract
Aim To identify the most effective laxative for bowel preparation in unsedated colonoscopy. Methods Between April 2019 and April 2020, a total of 586 outpatients scheduled for unsedated colonoscopy at the First Hospital of Jilin University (Changchun, China) were randomized into one of two groups, namely, the polyethylene glycol (PEG) group or the oral sodium phosphate solution (OSP) group. The cleaning efficiency and other relevant clinical parameters were compared between the two groups. Results Each group consisted of 293 patients. There were no significant differences in gender, body mass index, and history of abdominal surgery between the two groups. There were more cases of laxative intolerance in the PEG group than in the OSP group (7.5% vs. 0.7%, P < 0.05). After tube insertion, we found that the cleaning efficiency of OSP was better than that of PEG (P < 0.05). After cleaning, there was no significant difference in bowel cleanliness between the two groups (P > 0.05). The colonoscopic insertion time of the PEG group was significantly shorter than that of the OSP group (10.0 vs. 12.0 min, P = 0.002), and colonoscopic insertion was more difficult in the OSP group than in the PEG group (P = 0.036). The VAS score of the PEG group patients was significantly lower than that of OSP group patients (4.0 ± 1.3 vs. 5.2 ± 1.7, P ≤ 0.001). There were no significant differences in the cecal intubation rate and the detection rate of polyps and ulcers/erosion between the two groups. Conclusion The cleaning efficiency and tolerability of OSP were preferable to those of PEG, but there was no significant difference in bowel cleanliness after washing the colon and suctioning the fluid. Compared with patients of the OSP group, those of the PEG group required a shorter colonoscopic insertion time and reported a more comfortable experience. Therefore, for cases that are tolerant of PEG, PEG is a better choice for unsedated colonoscopy.
Highlights
Adequate bowel preparation is the premise of successful colonoscopy, and inadequate bowel preparation has a detrimental effect on the procedure [1,2,3]
There are few studies in the literature comparing the efficacies of polyethylene glycol (PEG) and oral sodium phosphate (OSP) in cleaning the bowel for colonoscopy [8,9,10, 14]
There is no reported case of severe kidney injury or another related complication caused by the use of OSP, which may be related to the colonoscopy protocol followed by our center, whereby patients consume at least 1700 mL of fluid to protect the function of the kidneys [15]
Summary
Adequate bowel preparation is the premise of successful colonoscopy, and inadequate bowel preparation has a detrimental effect on the procedure [1,2,3]. Colonoscopy with sedation has been widely applied, some patients still choose unsedated colonoscopy [4, 5]. Because of the characteristics of unsedated colonoscopy, clinicians and medical staff need to be mindful of laxative tolerability and pain during colonoscopy [6] as well as the outcomes of the procedure. These three parameters are directly related to the laxative used. We use both PEG and OSP for bowel preparation in patients without contraindications. This study compared the efficacy and tolerability of two laxatives to determine which one is more suitable for bowel preparation in unsedated colonoscopy
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