Electrolyte Lavage Solution Research Articles

Lubiprostone plus polyethylene glycol electrolyte lavage solution (PEG-ELS) versus PEG-ELS for bowel preparation in chronic constipation: a randomized controlled trial

Colonoscopy is considered the standard procedure for early detection and prevention of colorectal cancer. Adequate bowel cleansing is an important determinant of the efficacy of colonoscopy screening. Currently, there is no standard method of bowel preparation for patients with chronic constipation. The aim was to access the rate of adequate bowel cleansing achieved using split-dose polyethylene glycol electrolyte lavage solution (PEG-ELS) plus lubiprostone in comparison with split-dose PEG-ELS alone. A single-centre, endoscopist-blinded, randomized controlled trial was conducted. Seventy-eight constipated patients aged 18–75 years who were indicated for colonoscopy in the gastroenterology unit of Srinagarind Hospital, Khon Kaen University, between February 2020 and February 2021 were randomly allocated to receive either split-dose PEG-ELS in combination with lubiprostone (N = 39) or split-dose PEG-ELS alone (N = 39) before colonoscopy. Adequate bowel cleansing was defined as an Ottawa bowel preparation score ≤ 7. The rate of adequate bowel cleansing was comparable between the PEG-ELS plus lubiprostone group and the PEG-ELS alone group (50% vs. 52.9%, p value = 0.81) with a relative risk of 1.13 (95% CI = 0.43–2.91). There were no significant differences in adenoma detection rate (41.2% vs. 35.3%, p value = 0.62), adverse events, acceptance, compliance, or patient satisfaction between the 2 groups. No additional benefit to successful bowel preparation was achieved by the combination of lubiprostone and PEG-ELS in chronic constipation patients undergoing colonoscopy.

Observation of the application effect of low-volume polyethylene glycol electrolyte lavage solution (PEG-ELS) combined with ascorbic acid tablets in bowel preparation for colonoscopy in hospitalized patients

This study explored the effectiveness and safety of low-volume polyethylene glycol electrolyte lavage solution (PEG-ELS) combined with ascorbic acid tablets (PEG-ELS/Asc) in bowel preparation for a colonoscopy. A total of 240 hospitalized patients who underwent a colonoscopy in Wenzhou People's Hospital, Wenzhou Third Clinical College of Wenzhou Medical University from July 2020 to June 2022 were randomly divided into two groups, with 120 patients each. All of the participants were given a low-residue or residue-free diet one day before the examination and fasted after dinner (completed before 18:00) the day before the examination. The 2-L PEG-ELS/Asc group took 2-L PEG-ELS plus 10g ascorbic acid tablets once orally, while the 3-L PEG-ELS group took 3-L PEG orally on several occasions. The primary endpoint was the achievement of preparation adequacy and an overall colon cleansing score of ≥6, both assessed by blinded investigators using the Boston Bowel Preparation Scale (BBPS). The bowel cleansing effect, polyp detection rate, adverse reaction rate, oral drug tolerance rate, renal function, and electrolyte level changes were also compared between the two patient groups. There were no significant differences in the success rate of bowel preparation, the detection rate of polyps, or the adverse reaction rate between the two groups (P > 0.05). The tolerance rate of bowel preparation in the 2-L PEG-ELS/Asc group was significantly higher than that in the 3-L PEG-ELS group (93.3% vs. 80.23%) (P < 0.05). The levels of creatinine, serum potassium, serum sodium, and serum chlorine of the two groups before and after bowel preparation were within the normal range. In addition, the intestinal cleaning effect of the two preparation schemes for the hospitalized patients with diabetes and constipation is worse than that of those without these conditions (P < 0.05). The effectiveness and safety of using 2-L PEG-ELS/Asc in bowel preparation for a colonoscopy in hospitalized patients were not inferior to using 3-L PEG-ELS. For patients with diabetes and constipation, the cleansing effect of the two bowel preparation options was not very satisfactory, and further clinical research is needed in this regard.

Optimal Laxatives for Oral Colonoscopy Bowel Preparation: from High-volume to Novel Low-volume Solutions

Optimal bowel preparation is essential for a more accurate, comfortable, and safe colonoscopy. The majority of postcolonoscopy colorectal cancers can be explained by procedural factors, mainly missed polyps or inadequate examination. Therefore the most important goal of optimal bowel preparation is to reduce the incidence of colorectal cancer. Although adequate preparation should be achieved in 85-90% or more of all colonoscopy as a quality indicator, unfortunately 20-30% shows inadequate preparation. Laxatives for oral colonoscopy bowel preparation can be classified into polyethylene glycol (PEG)-electrolyte lavage solution, osmotic laxatives, stimulant laxatives, and divided into high-volume solution (≥3 L) and low-volume solution (<3 L). The updated 2019 European Society of Gastrointestinal Endoscopy (ESGE) guideline is broadly similar to the 2014 American Society for Gastrointestinal Endoscopy (ASGE) recommendations and reaffirms the importance of split-dosing. However, new ESGE guideline, unlike the 2014 ASGE recommendation, suggests the use of high volume or low volume PEG-based regimens as well as that of non-PEG based agents that have been clinically validated for most outpatient scenarios. For effective, safe, and highly adherent bowel preparation, physicians who prescribe and implement colonoscopy should properly know the advantages and limitations, the dosing, and the timing of regimens. Recently many studies have attempted to find the most ideal regimens, and more convenient, effective, and safe regimens have been developed by reducing the dosing volume and improving the taste. The high tolerability and acceptability of the new low-volume regimens suggest us how we should use it to increase the participation of the national colorectal cancer screening program.

518 Optimizing Inpatient Colonoscopy Preparation: A QI Project

INTRODUCTION: Hospitalization is an independent risk factor of poor bowel preparation and it has a lower procedure completion rate as compared to outpatients. Ineffective inpatient colonoscopy preparation may lead to delayed or canceled procedures which subject the patient to additional bowel preparation and sedation. Subsequently it results in patient inconvenience, increased cardio-pulmonary complications, longer hospital stays, and increased hospital cost. METHODS: Defining the problem: Chart review of the inpatient colonoscopies performed between May and July 2017 revealed that 4 liters-single dose polyethylene glycol–electrolyte lavage solution [PEG-ELS] was used in more than 90% of the inpatient colonoscopies. The percentage of colonoscopies with a rating of fair or poor was 36%. On average, 15% of patients failed inpatient bowel preparation. Aim of the project: To reduce the percentage of failed inpatient colonoscopies to less than 10% by May 2018 and to reduce the percentage of inpatients colonoscopies with an inadequate bowel preparation by 5% by May 2019. Interventions: 1) Fellows education on the evidence based split-dose regimen. 2) Bowel prep quality deemed adequate if cecal intubation was successful and prep was satisfactory to identify the targeted lesions. 3) Nothing by mouth orders to be started at 4 am or later instead of traditional after midnight orders. 4) Notify MD orders if the patient has any problem with the bowel prep to enhance communication with nurses. 5) As needed orders for nasogastric tube placement for administration of the prep. 6) An order set was implemented in Epic to facilitate the process and make it uniform. RESULTS: After the first PDSA cycle (Sep 2017-May 2018), we were able to reduce the percentage of failed inpatient colonoscopies from an average of 15% to less than 5% and we reduced the percentage of inadequate bowel prep by 4% (Goal of 5%). In the second PDSA cycle (May 2018-May 2019), we maintained the percentage of failed inpatient bowel preparation under 10% (4.2-7.5%) and reduced the percentage of inadequate bowel prep 17% from the baseline. CONCLUSION: Implementing a split-dose regimen of 4 liter PEG-ELS for all inpatient colonoscopies, improving communication between nurses and ordering physicians, and executing a standard order set for bowel prep orders and instructions are successful strategies in optimizing inpatient bowel preparation. The reliability of the bowel preparation quality scales needs to be validated for use in inpatient colonoscopies.

Can a 1-day clear liquid diet with a split -dose polyethylene glycol overcome conventional practice patterns during the preparation for screening colonoscopy?

A successful screening colonoscopy is closely linked to the quality of a bowel preparation. In this study, we aimed to determine the impact of a 1-day clear liquid diet (CLD) compared to a 3-day combined diet (CMD) accompanied by a split-dose regimen of polyethylene glycol and electrolyte lavage solution (PEG-ELS) for screening colonoscopy. This was a prospective, randomized, endoscopist-blinded study. Patients referred for screening colonoscopy were randomized to four groups as a 1-day CLD+PEG-ELS vs. a 1-day CLD+sulfate free (SF)-PEG-ELS and a 3-day CMD+PEG-ELS vs. a 3-day CMD+SF-PEG-ELS. An assessment of the quality of colon cleaning, tolerability to the preparation, and symptoms related to the preparation were recorded. A total of 506 patients were enrolled in this study. The quality of bowel preparation was significantly inferior in the CMD+PEG-ELS group than CLD+PEG-ELS (p=0.004) and CMD+SF-PEG-ELS groups (p=0.007). There were no statistical differences among the groups in terms of the polyp detection rate. With respect to an easy rating of diet following and the consumption of laxative, there were no significant differences among the four groups. Gastric fullness and nausea/vomiting were pointed out much more, especially in the SF-PEG-ELS users (p=0.008 and p=0.004, respectively). A 1-day CLD was not inferior to a 3-day CMD for colonoscopy preparation in terms of bowel cleaning, the polyp detection rate, and patient tolerance.

Polyethylene glycol electrolyte lavage solution increases tablet dissolution of acetaminophen in an in vitro model mimicking acute poisoning

IntroductionPolyethylene glycol electrolyte lavage solution (PEG-ELS) is similar to pharmaceutical solvent propylene glycol and used following acute poisonings for whole bowel irrigation (e.g., “body stuffing”). This raises concern of PEG-ELS increasing solubility following acute ingestions of non-sustained release xenobiotics in the stomach. We theorized PEG-ELS increases solubility of acetaminophen in an in vitro stomach model. Material and methodsAn in vitro artificial stomach with 500 mL simulated gastric fluid and either 500 mL of sodium chloride 0.9% (group A) or 500 mL of PEG-ELS (group B). Ten non-sustained release acetaminophen tablets added with concentrations 0, 15, 45 and 90 min in triplicate. Mean concentrations and mean area under the curve (AUC) (mg-min/L to 90 min). ResultsIn control group A (normal saline + simulated gastric fluid) mean acetaminophen concentrations 0, 3, 13 and 36 mg/L at 0, 15, 45 and 90 min, respectively. In group B (PEG-ELS + simulated gastric fluid) mean acetaminophen concentrations 0, 34, 109 and 136 mg/L at 0, 15, 45 and 90 min, respectively (p < 0.05). Mean AUC 0-90 1385 [95% C.I. 990.5–1779] mg-min/L in control group A compared to mean AUC 0-90 in group B (PEG-ELS) 7673 mg-min/L [95% C.I. 4832–10513] (p < 0.05). DiscussionGroup B (PEG-ELS) with significantly higher mean acetaminophen concentrations and greater mean AUC compared to control group A (normal saline). ConclusionWe demonstrated increased mean acetaminophen concentrations and increased mean AUC of following exposure of PEG-ELS in an artificial stomach model.

Application of care bundles in bowel preparation for colonoscopy in children.

To explore the value of care bundles (CBs) in bowel preparation for colonoscopy in children. Children who underwent electronic fiberoptic colonoscopy or enteroscopic surgery in our hospital from September 2016 to October 2017 were enrolled as the conventional nursing (CN) group and children who received such procedures from November 2017 to December 2018 were enrolled as the care bundle group. Polyethylene glycol electrolyte lavage solution (PEG-ELS) was used for bowel preparation in all children. The CBs included nurse education, risk evaluation of inadequate bowel preparation, education of children and families, and observation and assessment during preparation. The quality of bowel preparation, tolerance and safety, families' anxiety score, and degree of satisfaction with hospitalization were compared between these two groups. Eighty-two children were enrolled in this study, with 42 cases in the CB group and 40 cases in the CN group. Symptoms of distension, abdominal pain, vomiting, and fatigue, along with intragastric feeding, were compared between the two groups. An additional enema was performed in 2 cases in the CB group and in 12 cases in the CN group, demonstrating a significant difference between the groups. The Aronchick score and anxiety score of families were 1.24±0.85 vs. 2.35±1.76 (t=-3.477, P=0.001) and 3.28±0.85 vs. 5.45±1.78 (t=-3.473, P=0.001) in the CN group and CB group, respectively. The satisfaction rate was 97.62% vs. 85.00% (χ2=6.764, P<0.001). Implementation of the care bundles in the bowel preparation of children planning to receive colonoscopy can improve the quality of preparation and the satisfaction with hospitalization while alleviating the anxiety of patients and their families.

Influencing factors of different bowel preparation regimens on the quality of colonoscopy

Objective To explore the influencing factors of different bowel preparation before colonoscopy on the intestinal cleanliness and polyp detection rate. Methods From March to August in 2018, at the Center of Endoscopy of Huashan Hospital Affiliated to Fudan University, the patients who underwent colonoscopy were selected and their general data of bowel preparation regimens were collected. Self-factors of the patients, different bowel preparation regimens, bowel preparation quality and polyp detection rate were observed. The quality of bowel preparation was evaluated by Boston bowel preparation scale (BBPS). T test, and analysis of variance and chi-square test were used for statistical analysis. Results Among 1 008 patients who underwent colonoscopy, there were 506 males and 502 females, and average age was (57.3±13.7) years. There were statistically significant differences in BBPS score of patients with different body mass index (BMI), Parkinson disease and history of abdominal surgery (F=3.319, t=-2.060 and -2.544; all P<0.05). The BBPS score of patients with three-day low residue diet before examination was higher than that of those without preparation before examination (6.04±2.50 vs. 5.54±2.73), and the difference was statistically significant (t=2.514, P=0.010). The BBPS scores of 2 000 mL polyethylene glycol electrolyte lavage solution (PEG) taken once, 2 000 mL PEG taken separately, 3 000 mL PEG taken once and 3 000 mL PEG taken separately were 5.06±2.88, 6.11±2.44, 5.94±2.32 and 6.10±2.47, respectively, and the difference was statistically significant (F=7.242, P<0.01). There were significant differences in polyp detection rates among the patients with different age, gender, BMI, and with history of constipation, hypertension and diabetes mellitus (χ2=33.170, 8.489, 12.024, 4.034, 26.790, 10.381; all P<0.05). The polyp detection rate of patients with oral methyl silicone oil was higher than that of patients without oral methyl silicone oil (52.6%, 30/57 vs. 29.7%, 221/744), and the difference was statistically significant (χ2=12.934, P<0.01). Age (odds ratio (OR)=1.328, 95% confidence interval (CI) 1.162 to 1.517) and BMI (OR=1.412, 95%CI1.115 to 1.787) were independent risk factors for polyp detection rate. Conclusions Parkinson disease, history of abdominal surgery and BMI are the related factors affecting the quality of bowel preparation before colonoscopy. Age and BMI are independent risk factors for polyp detection rate. Key words: Colonoscopes; Polyethylene glycols; Bowel preparation; Simethicone

Efficacy and tolerability of various bowel preparations in diabetic patients: a randomized controlled trial.

Background and study aims Diabetes mellitus (DM) is an independent risk factor for poor bowel preparation prior to colonoscopy. Bisacodyl is a stimulant laxative that may mitigate colonic dysmotility associated with diabetes. We hypothesized that adding bisacodyl to split-dose bowel preparation (SDBP) would improve the quality of bowel preparation among patients with diabetes. Patients and methods Adult outpatients aged 18 to 80 years undergoing colonoscopy were recruited. One hundred and eighty-six patients with diabetes were randomly assigned to 1 of 3 treatment arms: 1) conventional 4 L of polyethylene glycol electrolyte lavage solution (PEG-ELS; conventional bowel preparation [CBP]); 2) split-dose of 4 L PEG-ELS (split-dose bowel preparation [SDBP]); or 3) split-dose of 4 L PEG-ELS preceded by 10 mg of oral bisacodyl 10 (SDBP-B). The primary outcome measure was bowel cleansing as indicated by Boston Bowel Preparation Scale (BBPS) score. Endoscopists were blinded to the preparation used. Secondary outcome measures were safety and patient tolerability. Results Of the 212 patients randomized, only 186 received assigned bowel preparation. There were no differences among the three study groups with regard to age, indication, duration of DM, insulin use, narcotic use, or presence of end-organ diabetic complications. There was a trend toward better bowel preparation quality among those receiving SDBP and SDBP-B compared to those receiving CBP, but the trend was not statistically significant ≥ 6 BBPS; 67 % vs. 83 % vs. 75 %, P = 0.1). In terms of safety and tolerability, there were no differences among the three groups. Conclusion Adding bisacodyl to SDBP does not improve the quality of bowel preparation in patients with DM. Further efforts are needed to optimize colonoscopy bowel preparation in this population.

Evaluation of the effect of GLP‐1 agonists on quality of bowel preparation for colonoscopy in patients with diabetes

AbstractPeople with diabetes mellitus warrant a greater need for colonoscopy owing to the increased risk of colorectal cancer and autonomic neuropathy. Unfortunately, this population is reported to have a higher proportion of inadequate bowel preparation during colonoscopy, which translates into lower adenoma detection rates and repeat colonoscopies. Glucagon‐like peptide‐1 (GLP‐1) agonists commonly used in the management of diabetes are well known to cause delayed gastrointestinal (GI) transit times, yet it is unknown if they contribute to the higher frequency of inadequate bowel preparation in people with diabetes.Therefore, we conducted a retrospective medical record analysis of type 2 diabetic patients aged 45–75 who had an outpatient colonoscopy between 2012 and 2015. Our patients were taking either Byetta, Victoza or Bydureon and the method of bowel preparation used was polyethylene glycol electrolyte lavage solution. Patients who had a diagnosis of conditions known to cause delayed GI transit times (autonomic neuropathy, GI surgery, stroke and multiple sclerosis) were excluded. The final pool consisted of 126 diabetic patients taking a GLP‐1 agonist and a control group of 129 diabetic patients who were not taking this class of medication. The percentage of satisfactory bowel preparations in the group taking a GLP‐1 agonist was 92.06% and in the control group was 92.25%. Chi‐squared p‐value for significant difference between these two groups was p = 1.0 (95% confidence interval −0.066 to 0.069). Hence there were no significant differences in bowel preparation among diabetic patients taking GLP‐1 agonists vs the control group; GLP‐1 agonists can therefore continually be used according to the current standard protocols for colonoscopy before and after colonoscopy. Copyright © 2017 John Wiley &amp; Sons.

Optimal intake of clear liquids during preparation for afternoon colonoscopy with low-volume polyethylene glycol plus ascorbic acid.

Background and study aims The standard colonoscopy preparation regimen in Japan for afternoon procedures is sequential intake of 1 L of polyethylene glycol electrolyte lavage solution containing ascorbic acid (PEG-ASC), 0.5 L of clear liquid, 0.5 L of PEG-ASC, and finally 0.25 L of clear fluids (all at a rate of 0.25 L every 15 min). However, this regimen seems poorly tolerated and complicated for many patients compared to previous regimen of polyethylene glycol electrolyte lavage solution. The aim of this study was to evaluate an alternate regimen of 0.5 L of PEG-ASC followed by 0.25 L clear liquids, repeated 3 times. Patients and methods This was a single-blinded, non-inferiority, randomized controlled study. Subjects were randomized to the standard regimen or the alternate regimen using a web-based registry system. All patients were instructed to eat a pre-packaged, low residue diet and to take sodium picosulfate hydrate the day before colonoscopy. The Boston Bowel Preparation Scale was used to evaluate bowel cleansing, and a 3-point scale was used to assess mucosal visibility. The primary endpoint was successful bowel cleansing. The acceptability, tolerability, safety, and endoscopic findings of these two regimens were secondary endpoints. Results A total of 409 patients were randomized to either the standard regimen (n = 204, males 54.0 %, mean age 65.5 years) or the alternate regimen (n = 205, 54.6 %, 65.0 years). The rates of successful bowel cleansing were 71.1 % (64.3 – 77.2 %) with the standard regimen vs. 75.1 % (68.6 – 80.9 %) with the alternate regimen (95 % lower confidence limit, for the difference = – 4.6, non-inferiority P < 0.05). No significant differences were found in tolerability, safety, and endoscopic findings. Conclusion The alternate regimen and standard regimen are clinically equivalent with respect to cleansing efficacy and acceptability, tolerability, safety, and endoscopic findings. These results are good news for patients with difficulty drinking the first liter of PEG-ASC.

小児大腸内視鏡検査における前処置法の検討 : Golytely 液の投与法と評価

小児大腸内視鏡検査における前処置法の検討 : Golytely 液の投与法と評価

The Influence of Polyethylene Glycol Solution on the Dissolution Rate of Sustained Release Morphine.

Whole bowel irrigation (WBI) is a management option for overdose of medications poorly adsorbed to activated charcoal, with modified release properties, or for body packers. Polyethylene glycol (PEG) is a mixture of ethylene oxide polymers of varying molecular weight. PEG with an average molecular weight of 3350g/mol is used for WBI. PEG electrolyte lavage solution has been shown in vitro to hasten the dissolution of acetaminophen. The impact of PEG on the pharmacokinetics of extended release pharmaceuticals is unknown. Lower average molecular weight PEG mixtures are used as solvents and excipients. We sought to investigate the impact of PEG on the release of morphine from several extended release morphine formulations. An in vitro gastric model was developed. To test the validity of our model, we first investigated the previously described interaction of ethanol and Avinza®. Once demonstrated, we then investigated the effect of PEG with several extended release morphine formulations. In the validation portion of our study, we confirmed an ethanol Avinza® interaction. Subsequently, we did not observe accelerated release of morphine from Avinza® or generic extended release morphine in the presence of PEG. The use of PEG for gastric decontamination following ingestion of these extended release morphine formulations is unlikely to accelerate morphine release and aggravate intoxication.

Efficacy of polyethylene glycol electrolyte lavage solution with ascorbic acid for bowel preparation for CT colonography

Efficacy of polyethylene glycol electrolyte lavage solution with ascorbic acid for bowel preparation for CT colonography

An Investigator-Blinded Randomized Controlled Prospective Study Comparing Efficacy, Tolerability, and Safety of Two Bowel Preparations in the Community Setting: Miralax Versus PEG Electrolyte Lavage Solution (PEG-ELS)

Introduction: Although not FDA approved, Miralax (PEG 3350) mixed with Gatorade is a frequently used colonoscopy bowel preparation. There is conflicting data regarding its efficacy and tolerability, and limited data on its safety. We aimed to compare the efficacy, tolerability and safety of Miralax with Gatorade and PEG-ELS (polyethylene glycol electrolyte lavage solution) in the community setting. Methods: Patients undergoing elective screening colonoscopy were randomized to receive either splitdosed Miralax or PEG-ELS. Serum electrolytes, calcium, and phosphorus were determined before and after the preparation. Patients completed a Likert scaled questionnaire (1 = strongly agree; 5 = strongly disagree) evaluating their experience with the preparation just before colonoscopy. Quality of preparation was scored by blinded endoscopists using the Boston Bowel Preparation Scale (BBPS). Results: Sixty seven patients received either Miralax (N=38) or PEG-ELS (N=29). The groups were comparable regarding age, sex, and race.There was no significant difference in efficacy between the Miralax and PEG-ELS groups, with mean total BBPS scores of 7.34 and 7.82, respectively (p=.153). There was no significant difference in the ability to complete at least 75% of the preparation between the groups, but more patients were willing to retake (29.1 vs 40.4; p=.008) and/or recommend (28.5 vs 41.1; p=.003) their Miralax preparation in the future. The Miralax group also found the amount of preparation (27.9 vs 41.9, p=.001) and its taste (26.3 vs 44, p < .001) more acceptable and their preparation to be more tolerable (27.4 vs 42.6, p < .001). The Miralax group experienced less headache than the PEG-ELS group (29.2 vs 40.1, p=.003) but there was otherwise no significant difference in side effects. Finally, there was no significant difference in serum electrolytes before and after taking the preparations in either group. Conclusion: Both split-dosed preparations are effective at colon cleansing without adverse changes in serum electrolytes. However, patients in the Miralax group found their preparation to be more tolerable than those in the PEG-ELS group. Additionally, more patients were in favor of using or recommending Miralax again in the future. This study adds to the growing body of data regarding bowel preparation regimens and supports the effectiveness and safety of Miralax in preparing the bowel for colonoscopy with improved patient acceptance and tolerability.

Effect of lactulose oral solution combined with PEG-4000 electrolyte lavage solution on bowel preparation before colonoscopy

Objective To compare the effectiveness of lactulose oral solution combined with PEG-4000 electrolyte lavage solution with PEG-4000 electrolyte lavage solution only in colonoscopy preparation. Methods A total of 121 patients preparing for colonoscopy were randomly divided into two groups: 61 patients in lactulose oral solution combined with PEG-4000 electrolyte lavage solution group(the experimental group=group A), and 60 patients in PEG-4000 electrolyte lavage solution group(the control group=group B). During the colonoscopy, the endoscopist blindly scored the cleanness of the bowel, and recorded any adverse event to assess the safety. Results According to the Boston bowel preparation scale, the experimental group scored 7.07±0.79, and the control group scored 6.18±1.03, which showed significant significance(P=0.000). There was no significant difference in the time of accessing rectum between the two groups[(8.80±1.74)min VS(9.22±1.94)min, P=0.220]. Polyp detection rate in group A was higher than that in group B, with no significant difference(22.95% VS 15.00%, P>0.05). The small polyp(≤0.5 cm)detection rate in group A was higher than that in group B with significant significance(P=0.038). No adverse event was recorded in either group. Conclusion The bowel preparation with lactulose oral solution combined with PEG-4000 electrolyte lavage solution is more effective than that with PEG-4000 electrolyte lavage solution alone. It will enhance the detection rate of small polyps with no evident adverse reactions. Key words: Colonoscopy; Bowl preparation; Lactulose; Polyethylene Glycols

A Randomized Controlled Trial Evaluating a Low-Volume PEG Solution Plus Ascorbic Acid versus Standard PEG Solution in Bowel Preparation for Colonoscopy.

Evaluation of polyethylene glycol electrolyte lavage solution containing ascorbic acid (PEG-ASC) has been controversial in the point of its hyperosmolarity, especially in old population. So we therefore designed the present study to compare the efficacy, acceptability, tolerability, and safety of 1.5 L PEG+ASC and 2 L standard PEG electrolyte solution (PEG-ELS), not only in the general population, but also in patients of advanced age. Randomization was stratified by age (<70 years or 70> years), and hematological and biochemical parameters were compared in each age group, especially with respect to the safety profile of each regimen. As a result, the 1.5-L PEG-ASC regimen had higher patient acceptability than the 2-L PEG-ELS regimen. Tolerability, bowel cleansing, and safety were similar between regimens. However, we demonstrated significant statistical changes in the hematological and biochemical parameters after taking bowel preparation solutions, not only in the PEG+ASC group, but also in the PEG-ELS group. No significant differences in the safety profile were found between subjects aged less than 70 years and those aged 70 years or more; nevertheless, regardless of age, proper hydration is needed throughout the bowel preparation process.

アスコルビン酸含有ポリエチレングリコール電解質製剤を用いた大腸内視鏡検査前処置法の検討（ポリエチレングリコール電解質製剤との比較）

目的：アスコルビン酸含有ポリエチレングリコール電解質製剤（PEG-Asc）を用いた大腸内視鏡検査前処置法の有効性や安全性，患者受容性を検証した．対象と方法：PEG-Asc群（255例）とポリエチレングリコール電解質製剤（PEG-ELS）群（237例）での比較試験を行った．結果：前処置所要時間はPEG-Asc群が129.7±55.5分，PEG-ELS群が149.2±61.5分と有意に短く（p＝0.0003），腸管洗浄剤服用量もPEG-Asc群が1,786±421ml，PEG-ELS群が1,906±332mlと有意に少なかった（p＝0.0005）．副作用発現率および腸管洗浄度に有意差は認めなかった．受容性は前処置所要時間が短いと感じた割合がPEG-Asc群で有意に多かった．結論：PEG-Ascを用いた前処置法は有効かつ安全であり，被験者に負担の少ない前処置法として有用と思われる．

Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US Multi-Society Task Force on Colorectal Cancer.

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

A randomized, controlled trial of oral sulfate solution plus polyethylene glycol as a bowel preparation for colonoscopy

No bowel preparation for colonoscopy is optimal with regard to efficacy, safety, and tolerability. New options for bowel preparation are needed. To compare a new hybrid preparation consisting of a reduced dose of oral sulfate solution (OSS) plus 2 L of sulfate-free electrolyte lavage solution (SF-ELS) with 2 low-volume preparations based on polyethylene glycol electrolyte lavage solution (PEG-ELS). Two randomized, controlled trials. Twenty-four U.S. centers. A total of 737 outpatients undergoing colonoscopy. In study 1, OSS plus SF-ELS was given as a split dose, and in study 2, OSS plus SF-ELS was given in its entirety the evening before colonoscopy. In study 1, the active control was 2 L of PEG-ELS plus ascorbic acid (PEG-EA) given as a split dose. In study 2, the control was 10 mg of bisacodyl plus 2 L of SF-ELS taken the evening before colonoscopy. Rates of successful (good or excellent) bowel preparation. In study 1, the rates of successful (excellent or good) preparation with OSS plus SF-ELS and PEG-EA were identical at 93.5% for split-dose preparation. OSS plus SF-ELS was noninferior to PEG-EA (P< .001). In study 2, OSS plus SF-ELS resulted in successful preparation in 89.8% of patients compared with 83.5% with bisacodyl plus SF-ELS in a same-day preparation regimen. OSS plus SF-ELS was noninferior to bisacodyl plus SF-ELS (P<.001). In study 1, vomiting was more frequent with OSS plus SF-ELS (13.5% vs 6.7%; P= .042), and bloating was rated worse with PEG-EA (P= .025). In study 2, overall discomfort was rated worse with OSS plus SF-ELS (mean score 2.1 vs 1.8; P= .032). There were no deaths in either study and no serious adverse events considered related to the preparation. Bowel cleansing was not scored by colon segment. Adenoma detection was not compared between the regimens. OSS plus SF-ELS is a new, safe, and effective bowel preparation for colonoscopy.