Standard Polyethylene Glycol Research Articles

Magnetic Resonance Enterography Reinvented: Exploring the Potential of a New Natural Beverage as an Alternative to Polyethylene Glycol Solution

The aim of the present study was to test a new oral contrast medium composed of natural components for the magnetic resonance (MR) imaging of small bowel diseases. Between January 2018 and June 2019, 35 patients affected by ileocolic Crohn’s disease (CD) were enrolled in the present study. Each patient underwent two sequential MR enterographies, first with the standard polyethylene glycol (PEG) water solution and, after 3 weeks, with the new natural beverage designed by our team. At the end of the administration of each oral contrast, a satisfaction survey was given to the patients to assess the palatability of both beverages. The intestinal distention and the quality of images were evaluated by two expert radiologists for both studies and the interreader agreement was calculated. According to the satisfaction questionnaire, 97.1% of patients expressed positive judgments regarding the natural beverage (71.4% very good and 25.7% good) whereas only 8.6% of them appreciated the PEG water solution (8.6% good) (p = 0.0001). The degree of intestinal distention was excellent and good in 97.1% of patients after the administration of PEG and in 94.3% of the patients after the administration of the natural beverage, without significant differences between the two products and with almost perfect (k = 0.821) and substantial (k = 0.754) inter-observer variability, respectively. No statistical differences were observed between the two expert radiologists regarding the evaluation of the imaging quality; in particular, they were considered good and excellent in 100% of patients after the administration of PEG water solution and in 97.2% of those who took the natural beverage, with substantial (k = 0.618) and almost perfect (k = 0.858) inter-observer variability, respectively. The new natural beverage demonstrated the same intestinal distension and excellent image quality compared to the synthetic standard oral contrast administered during MRE for small bowel diseases, proving to be a valid alternative with better palatability.

Low-dose of magnesium sulfate solution was not inferior to standard regime of polyethylene glycol for bowel preparation in elderly patients: a randomized, controlled study

Background Large polyethylene glycol (PEG) is a standard regimen for bowel preparation. However, elderly patients suffered from adverse events. This study was to compare the efficacy and safety of oral magnesium sulfate solution (MSS) vs standard PEG in elderly patients undergoing colonoscopy. Methods Elderly patients aged 60–90 years, from two endoscopic centers, were enrolled in China. Patients were randomized to take a low dose of MSS or a standard PEG regime in a split-dose regime. The primary endpoint was the proportion of patients with adequate bowel preparation, which was defined as the total Boston Bowel Preparation Scale (BBPS) ≥6 and each segmental BBPS was ≥2. Secondary outcomes included adenoma detection rate (ADR), safety, adverse events, cecal intubation rate, willingness to repeat BP, and so on. Results 1174 elderly patients were randomly allocated to the MSS group (n = 588) or the standard group (n = 586). Adequate BP was achieved in 94.0% of patients in the MSS group and 92.5% in the control (p = .287). ADR was also comparable between the two groups (43.0% and 39.9%, p = .282). Compared with the standard group, MSS group reported less abdominal discomfort (1.7% vs 6.0%), less nausea (13.6% vs 21.0%) and vomiting (1.2% vs 4.2%). The change in serum potassium levels after preparation in the standard group was significantly lower than that in the MSS group (−0.19 ± 0.08 vs −0.41 ± 0.11, p = .037). Conclusions Low dose of MSS was not inferior to the standard PEG regime in terms of bowel preparation quality for elderly patients. Low-dose MSS offered fewer adverse events and better tolerability. It is a preferable choice for the elderly to undergo bowel preparation for colonoscopy. Clinical trial registration number NCT 04948567

A comparison of exosome purification methods using serum of Marek's disease virus (MDV)-vaccinated and -tumor-bearing chickens

Marek's disease (MD) is an alphaherpesvirus (Marek's disease virus, MDV)-induced pathology of chickens associated with paralysis, immunosuppression, neurological signs, and T-cell lymphomas. MD is controlled in poultry production via live attenuated vaccines. The purpose of the current study was to compare methods for precipitating exosomes from vaccinated and protected chicken sera (VEX) and tumor-bearing chicken sera (TEX) for biomarker analysis of vaccine-induced protection and MD lymphomas respectively. A standard polyethylene glycol (PEG, 8%) method was compared to a commercial reagent (total exosome isolation reagent, TEI) for exosome yield and RNA content. Although exosomes purified by PEG or TEI were comparable in size and morphology, TEI-reagent yielded 3-4-fold greater concentration. Relative expression of 8 out of 10 G. gallus- and MDV1-encoded miRNAs examined displayed significant difference depending upon the precipitation method used. Standard PEG yields comparable, albeit lower amounts of exosomes than the TEI-reagent and a distinctive miRNA composition.

1462 Yellow Jacket in the Colon: An Incidental Finding During Screening Colonoscopy

INTRODUCTION: Findings arthropods in the GI system is rare, especially intact arthropods. We here by describe an intact yellow jacket found during a routine screening colonoscopy. CASE DESCRIPTION/METHODS: A 52-year-old Caucasian male presented for routine screening colonoscopy. His past medical history was significant for hypertension and anxiety. He had used standard polyethylene glycol solution bowel preparation the day prior to the procedure. Physical examination was unremarkable. Colonoscopic examination was unremarkable except for an intact dead yellow jacket in the descending colon. The insect was not retrieved. DISCUSSION: Findings arthropods in the GI system is rare. Ants and wasps in the stomach and cockroach, drosophila and flour bugs in the colon have been reported. In majority of the cases, these findings are likely due to inadvertent accidental ingestion. In some cultures, insects such as flour bugs are consumed intentionally and may be rarely found in the colon during colonoscopy. Majority of the reported arthropods in the GI system were intact denoting likely resistance of their complex exoskeleton to the human digestive system. Majority of the ingested arthropods pass through the GI tract uneventfully but rarely can cause barely noticeable local reaction to severe system anaphylactic reaction. Our patient denied any knowledge of how the insect could have entered in to his gastrointestinal tract. It is likely that he inadvertently swallowed the yellow jacket in his bowel preparation solution and the insect made it to the descending colon intact likely aided by the rapid transit effects of the polyethylene glycol solution.

Facile single-molecule pull-down assay for analysis of endogenous proteins

The single-molecule pull-down (SiMPull) assay analyzes molecular complexes in physiological conditions from cell or tissue lysates. Currently the approach requires a lengthy sample preparation process, which has largely prevented the widespread adoption of this technique in bioanalysis. Here, we present a simplified SiMPull assay based upon dichlorodimethylsilane—Tween-20 passivation and F(ab) fragment labeling. Our passivation is a much shorter process than the standard polyethylene glycol passivation used in most single-molecule studies. The use of F(ab) fragments for indirect fluorescent labeling rather than divalent F(ab′)2 or whole IgG antibodies allows for the pre-incubation of the detection antibodies, reducing the sample preparation time for single-molecule immunoprecipitation samples. We examine the applicability of our approach to recombinant proteins and endogenous proteins from mammalian cell lysates.

Safety and Efficacy of Low-Volume Preparation in the Elderly: Oral Sulfate Solution on the Day before and Split-Dose Regimens (SEE SAFE) Study.

Background/AimsThe use of a low-volume bowel cleansing agent is associated with a greater willingness to undergo repeat colonoscopy. Oral sulfate solution (OSS) is a recently approved low-volume agent; however, its efficacy and safety in the elderly population remain unclear. We aimed to evaluate the efficacy, safety, and acceptability of the OSS preparation, in comparison to those of a standard polyethylene glycol (PEG; 4 L) preparation, in elderly patients.MethodsA multicenter, randomized, investigator-blinded study was conducted. Participants were randomized to receive OSS or 4-L PEG with a split-dose regimen. Bowel cleansing efficacy was assessed using the Boston Bowel Preparation Scale (BBPS). Acceptance, satisfaction, and preparation-related symptoms were recorded. Additionally, blood parameters were analyzed for electrolyte abnormalities and nephrotoxicity.ResultsA total of 193 patients were analyzed. No group differences in overall bowel cleansing efficacy were observed, with “adequate” preparations achieved in 95.9% (93/97) and 94.8% (91/96) of patients in the OSS and 4L PEG groups, respectively (p=0.747). However, mean BBPS scores for the entire (p=0.010) and right colon (p=0.001) were significantly higher in the OSS group than in the 4-L PEG group. The severity of clinical adverse events and frequency of acute kidney injury were similarly low, and no clinically meaningful electrolyte changes were identified. Self-reported scores regarding amount (p<0.001) and feeling (p=0.007), as well as overall satisfaction (p=0.001) and willingness to repeat the preparation (92.8% vs 67.7%, p<0.001), were significantly better in the OSS group than in the 4-L PEG group.ConclusionsIn elderly individuals, OSS with a split-dose regimen has greater acceptability and comparable efficacy in bowel cleansing compared to 4-L PEG. (Clinical trials registration number: NCT03112967)

Comparative efficacy of low volume versus traditional standard volume PEG on bowel preparation before colonoscopy: Protocol for an updated meta-analysis with trial sequential analysis.

Polyethylene glycol (PEG) has been considered as the first recommendation for bowel preparation prior to colonoscopy. A previous meta-analysis suggested that low volume PEG may improve the acceptability of ingesting bowel preparation solution. However, several limitations impaired the power of findings from this published meta-analysis, such as the variation in study design of included trials and adjuvant prescriptions. Moreover, some studies related to this topic have been published recently. And thus, the aim of this updated meta-analysis is to further assess the comparative efficacy of low volume versus standard volume of PEG on bowel preparation before colonoscopy with trial sequential analysis (TSA). Systematic searches will be performed to capture any potential randomized controlled trials (RCTs) investigated the comparative efficacy of low volume versus traditional standard volume PEG on bowel preparation prior to colonoscopy in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. Moreover, we will also manually check the bibliographies of related studies and reviews so as to get additional studies. Two reviewers will independently screen the citation records, extract essential information, and appraise the risk of bias of each RCT in sequence. Finally, we will used the STATA software version 12.0 and TSA software version beta 0.9 to statistically analyze all data and test the robust of each pooled result, respectively. We will submit the full-text of systematic review to a peer-review journal for publication. This updated systematic review and meta-analysis with TSA will further assess the comparative efficacy and safety of low-volume versus traditional standard volume PEG for bowel preparation prior to colonoscopy. And then, a more comprehensive evidence body on low-volume compared to standard volume PEG in bowel preparation will be constructed.

P593 Efficacy, tolerance and safety of low-volume bowel preparations in inflammatory bowel diseases: Results from a French national multicentre study

Standard high-volume PEG (polyethylene glycol) bowel preparations are usually advised in inflammatory bowel disease (IBD) patients for colonoscopy. Other, low-volume, preparations may be used in clinical practice but very few study have evaluated their safety and tolerance. The aim was to evaluate efficacy, tolerance and safety of the various bowel preparations in IBD, including low-volume preparations. We conducted a French prospective multicentre observational study, during 1 month. Inclusion criteria were: patients aged 18–75 years, IBD or symptoms of IBD for at least 3 months, indication of colonoscopy independent from the study. The choice of the preparation was left to the investigators as per their usual protocol. Patients, disease and colonoscopy characteristics were recorded by physicians and patients were given self-reported questionnaires. Twenty-five public and private centres in France enrolled 278 patients. Among them, 44 had a disease flare at the time of colonoscopy and 41 had bowel stenosis. 42% received two litres polyethylene glycol with ascorbic acid (PEG 2L), 29% sodium picosulphate (Pico), 15% four litres PEG (PEG 4L) 4L and 14% received sodium phosphate (NaP) or sodium, magnesium and potassium sulphates (MPS). The preparation did not reach the efficacy outcome (Boston score ≥7) in the PEG 4L group in 51.2% of the patients (p = 0.0011). The preparation intake was complete for 59.5% in the PEG 4L group compared with 82.9% in the PEG 2L group and 93.8% in the Pico group (p < 0.0001). For all outcomes, tolerance assessed by patients and physicians visual analogue scale was significantly better with both Pico and PEG 2L compared with PEG 4L; and better with Pico compared with PEG 2L (p = 0.008 and p = 0.0003). Major tolerance endpoints (unpleasant taste, excessive thirst, nausea and vomiting) were significantly altered in the PEG 4L group. Adverse events occurred in 4.3% and were independent from the preparations. Low-volume preparations, including Pico and NaP were actually used by gastroenterologists for IBD patients in France. Preparations with PEG 2L and Pico achieved equally safe preparations, with better efficacy and fare better tolerance compared with high-volume PEG preparations. The best efficacy/tolerance/safety profile was achieved with the Pico preparation. These results need further confirmation by randomised trials.

Pancreatic and Intestinal Function Post Roux-en-Y Gastric Bypass Surgery for Obesity.

Objectives:Despite the fact that the most effective treatment for morbid obesity today is gastric bypass surgery, some patients develop life-threatening nutritional complications associated with their weight loss.Methods:Here we examine the influence of the altered anatomy and digestive physiology on pancreatic secretion and fat absorption. Thirteen post Roux-en-Y gastric bypass (RYGB) patients who had lost >100 lbs in the first year following surgery and who gave variable histories of gastrointestinal (GI) dysfunction, were selected for study. Food-stimulated pancreatic enzyme secretion and GI hormone responses were measured during 2 h perfusions of the Roux limb with a standard polymeric liquid formula diet and polyethylene glycol marker, with collections of secretions from the common channel distal to the anastomosis and blood testing. Fat absorption was then measured during a 72 h balance study when a normal diet was given containing ~100 g fat/d.Results:Result showed that all patients had some fat malabsorption, but eight had coefficients of fat absorption <80%, indicative of steatorrhea. This was associated with significantly lower feed-stimulated secretion rates of trypsin, amylase, and lipase, and higher plasma peptide-YY concentrations compared with healthy controls. Five steatorrhea patients were subsequently treated with low quantities of pancreatic enzyme supplements for 3 months, and then retested. The supplements were well tolerated, and fat absorption improved in four of five patients accompanied by an increase in lipase secretion, but body weight increased in only three. Postprandial breath hydrogen concentrations were elevated with some improvement following enzyme supplementation suggesting persistent bacterial overgrowth and decreased colonic fermentation.Conclusions:Our investigations revealed a wide spectrum of gastrointestinal abnormalities, including fat malabsorption, impaired food stimulated pancreatic secretion, ileal brake stimulation, and bacterial overgrowth, in patients following RYGB which could be attributed to the breakdown of the normally highly orchestrated digestive anatomy and physiology.

Addition of Lubiprostone to polyethylene glycol(PEG) enhances the quality & efficacy of colonoscopy preparation: a randomized, double-blind, placebo controlled trial.

BackgroundAdequate bowel preparation is an essential prerequisite for complete mucosal visualization during colonoscopy. Polyethylene glycol (PEG) solutions are commonly used. However the large volume of the solution is often poorly tolerated. Addition of Lubiprostone (LB) could improve the adequacy of standard PEG preparation & reduce requirement. The aims to assess adequacy of PEG preparation with addition of single dose LB (24mcg) vs placebo and efficacy of reduced dose PEG + LB compared with full dose PEG + LB.MethodsSingle center prospective double blind randomized controlled trial. Part I: 442 patients for colonoscopy randomized to receive placebo (GrA) or single dose of LB (GrB) prior to PEG preparation. Quality of bowel preparation graded 0–9 according to Boston Bowel Preparation Scale (BBPS). BBPS-9: excellent and BBPS 0–4: repeat procedure.Part II: 146 patients randomized to receive LB + 1.5 L PEG (GrC; 75) or LB + 1 L PEG (GrD; 71). BBPS score compared with GrB (2 L PEG).ResultsPart I: 442 patients (221 GrA & 221 Gr B). LB resulted in significant improvement in total BBPS (7.44 + 0.14 vs. 6.36 + 0.16, p < 0.0001). 66.5 % Gr B vs 38 % Gr A had excellent prep; 42.5 % GrB vs 24 % GrA had adequate prep. Repeat procedure needed 9.5 % Gr B vs 16.7 % Gr A (P < 0.01).Part II: No difference in BBPS scores with lower doses (Gr C&D) compared to standard (GrB) (Mean BBPS 7.44 + 0.14 GrA,7.30 + 0.25 GrC;7.25 + 0.26 GrD;p >0.05).ConclusionSingle dose LB prior to PEG significantly enhanced bowel preparation compared to PEG alone. There was no significant difference in quality of preparation with lower doses of PEG when combined with LB.Trial registrationThe study protocol was approved by institutional review board and the trial was registered on March 22, 2011 with clinicaltrials.gov (NCT01324284).

Uncharged Helical Modular Polypeptide Hydrogels for Cellular Scaffolds.

Grafted synthetic polypeptides hold appeal for extending the range of biophysical properties achievable in synthetic extracellular matrix (ECM) hydrogels. Here, N-carboxyanhydride polypeptide, poly(γ-propargyl-l-glutamate) (PPLG) macromers were generated by fully grafting the "clickable" side chains with mixtures of short polyethylene glycol (PEG) chains terminated with inert (-OH) or reactive (maleimide and/or norbornene) groups, then reacting a fraction of these groups with an RGD cell attachment motif. A panel of synthetic hydrogels was then created by cross-linking the PPLG macromers with a 4-arm PEG star molecule. Compared to well-established PEG-only hydrogels, gels containing PPLG exhibited dramatically less dependence on swelling as a function of cross-link density. Further, PPLG-containing gels, which retain an α-helical chain conformation, were more effective than standard PEG gels in fostering attachment of a human mesenchymal stem cell (hMSC) line for a given concentration of RGD in the gel. These favorable properties of PPLG-containing PEG hydrogels suggest they may find broad use in synthetic ECM.

A randomized, prospective trial on efficacy and tolerability of low-volume bowel preparation methods for colonoscopy

BackgroundLow-volume bowel preparations have been shown to provide an equivalent cleansing effect as that of a standard 4L polyethylene glycol. However, studies comparing the efficacy of low-volume bowel preparations are few, and the results have been controversial. This study aimed to compare the bowel cleansing quality and tolerability between sodium picosulfate/magnesium citrate and polyethylene glycol with ascorbic acid. MethodsA randomized study was performed with two hundred outpatients who were prospectively enrolled. The Boston Bowel Preparation Scale and the Aronchick scale were used to evaluate the bowel cleansing quality, and bubble scoring was also performed to back up both results. To investigate patients’ preferences and tolerability, a questionnaire was administered. ResultsSodium picosulfate/magnesium citrate was not inferior to polyethylene glycol with ascorbic acid in terms of successful bowel preparation (≥6 Boston scale score: 80% vs. 82%; p=0.718, adequate Aronchick grade: 93% vs. 96%; p=0.352). In addition, sodium picosulfate/magnesium citrate caused fewer gastrointestinal symptoms, and tasted better than polyethylene glycol with ascorbic acid. ConclusionsSodium picosulfate/magnesium citrate was not inferior to polyethylene glycol with ascorbic acid in cleansing efficacy, and was found to have higher tolerability.

Su1556 A Comparison of a Standard Volume Polyethylene Glycol Solution and Low Volume Polyethylene Glycol Plus Ascorbic Acid As Bowel Preparation Prior to Screening Colonoscopy

Low volume PEG plus ascorbic acid and standard volume PEG solutions are commonly used as bowel preparation prior to colonoscopy but comparative studies report conflicting results. The study aimed to compare these solutions prior to screening colonoscopy.

Full-dose Miralax® with Gatorade® for Bowel Preparation: A Meta-analysis of Randomized Controlled Trials

Purpose: Polyethylene glycol (PEG) is the most popular bowel preparation for colonoscopy. However, the large volume required in the standard preparation and salty taste results in reduced patient compliance. Recently, Miralax® (PEG without electrolytes) with Gatorade® has become popular both for its palatability and its lower volume. A number of randomized controlled trials comparing full-dose standard PEG with Miralax®-Gatorade® have been performed with mixed results. Therefore, we conducted a meta-analysis to evaluate the outcomes with full-dose Miralax®-Gatorade® versus full-dose PEG for bowel preparation prior to colonoscopy. Methods: MEDLINE/PubMed, Embase, Cochrane databases, CINAHL, Scopus, and recent abstracts from major conference proceedings were searched (5/2013). Three randomized controlled trials (RCTs) on adults comparing full-dose Miralax®-Gatorade® (238-255g in 64 ounces) versus full-dose PEG (4L) for bowel preparation prior to colonoscopy were included. The effects were analyzed by calculating pooled estimates of quality of bowel preparation (satisfactory, unsatisfactory, excellent), patient tolerance (nausea, cramping, bloating), and polyp detection by using odds ratio (OR) with fixed and random effects models. Publication bias was assessed by funnel plots. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency. RevMan 5.1 was utilized for statistical analysis. Results: Four trials met inclusion criteria (N=1,021) with mean age ranging from 56.3-61.3 years. Full-dose Miralax®-Gatorade® preparation demonstrated a statistically significant increase in patients' willingness to repeat preparation (OR 8.14; 95% CI: 5.51-12.01, p<0.01) as compared to full-dose PEG. No statistically significant difference was observed between the two groups for satisfactory preparations (OR 1.19; 95% CI: 0.68-2.07, p=0.54), unsatisfactory preparations (OR 0.83; 95% CI: 0.48-1.46, p=0.53), or polyp detection (OR 1.04; 95% CI: 0.79-1.37, p=0.78). No publication bias was noted. Conclusion: Full-dose Miralax®-Gatorade® preparation appears to be as efficacious as full-dose PEG but has increased patient satisfaction. Therefore, full-dose Miralax®-Gatorade® preparation may be used as an alternative to full-dose PEG for patients undergoing colonoscopy.

A low-volume polyethylene glycol plus ascorbate solution for bowel cleansing prior to colonoscopy: The NORMO randomised clinical trial

Patient acceptability of the preparation is a key factor in the success of colonoscopy, yet standard polyethylene glycol solutions are poorly tolerated owing to their high volume (4L) and low palatability. This study compared the efficacy, safety and acceptability of a 2L polyethylene glycol+ascorbate solution with a standard 4-L polyethylene glycol solution. Adults referred for colonoscopy were randomised to 2-L polyethylene glycol+ascorbate (n=202) or 4-L polyethylene glycol solution (n=198). Colon cleansing success was assessed using the Harefield Cleansing Scale(©) and the Aronchick scale. Safety and acceptability were also assessed. Successful cleansing was achieved in 94.1% and 90.9% of subjects with the 2-L and 4-L solutions respectively using the Harefield Cleansing Scale(©) and 94.6% and 90.0% using the Aronchick scale (non significant). Despite better acceptability and tolerability, no superiority over the standard 4-L preparation was demonstrated. Fewer treatment-related adverse events were reported with the 2-L solution (80.2% versus 89.9%, p=0.011). More subjects were willing to take the 2L PEG+ascorbate solution again (87% versus 51%, p<0.001), found it easier to drink (80% versus 70%, p=0.025), with a better taste (p=0.01). Two-litre polyethylene glycol+ascorbate solution, with a similar high degree of cleansing and superior acceptability and tolerability, presents an alternative to 4-L polyethylene glycol when compliance is an issue.

Tu1374 Low-Volume Morning-Only Polyethylene Glycol (PEG) With Specially Designed Test Meals vs. Standard-Volume Split-Dose PEG With Standard Diet for Colonoscopy: a Prospective, Randomized Trial

Split-dose PEG is a standard bowel preparation regimen for colonoscopy but large volume is burdensome to ingest and night dose makes sleep disturbance. This study was to evaluate the efficacy and tolerability of bowel preparation protocols using low volume morning-only PEG with specially designed low residue test meals (LV-PEG with TM) compared to standard volume split-dose PEG bowel preparation with standard diet instruction (SV-PEG with SD).

The Efficacy and Tolerability of Sugared Polyethylene Glycol for Colonoscopy

Although polyethylene glycol (PEG) solution is commonly used for colonoscopic bowel preparation because of its safety and effectiveness, its salty taste decreases patient's compliance. The aim of this study was to compare the sugared PEG solution with the standard PEG solution in regard to the quality of bowel preparation and patient's compliance. From January through June in 2012, 100 patients who underwent colonoscopy in Gangneung Asan Hospital were prospectively enrolled. They were randomly assigned to receive either standard PEG solution or sugared PEG solution. The quality of bowel preparation was assessed by a doctor's questionnaire and the patient's compliance was assessed by a patient's questionnaire. There was no significant difference in the quality of bowel preparation (4.2±2.0 vs. 4.1±1.5, p=0.783), and endoscopist's satisfaction score (8.2±1.8 vs. 8.5±1.3, p=0.253) between two groups. However, The degree of disgust was lower in the sugared PEG group than the standard PEG group (6.4±2.3 vs. 3.9±2.9, p=0.000). The willingness to repeat same regimen was higher in the sugared PEG group than the standard PEG group (2.0±0.6 vs. 2.3±0.7, p=0.004). There was no difference in side effects between two groups. The sugared PEG solution as a bowel preparation method revealed a higher patient's compliance and was effective as the standard PEG solution. When the patient dislike the taste and saltness of the standard PEG solution, the sugared PEG solution will be good alternative method.

Randomised clinical trial: low‐volume bowel preparation for colonoscopy ‐ a comparison between two different PEG‐based formulations

Low-volume bowel preparations with polyethylene glycol (PEG) have been shown to provide an equivalent cleansing with improved tolerability as compared with standard PEG bowel preparation for colonoscopy. A new iso-osmotic sulphate-free formulation of PEG-Citrate-Simethicone (PEG-CS) in combination with bisacodyl has been recently developed. To compare the quality of bowel cleansing with PEG-CS with bisacodyl vs. PEG-Ascorbate (PEG-ASC) in adult out-patients undergoing colonoscopy. Randomised, observer-blind, parallel group study in adult out-patients undergoing colonoscopy in five Italian centres. Both preparations were taken the evening before the procedure. Subjects were instructed to take 2-4 tablets of 5mg bisacodyl at 16:00hours and 2L of PEG-CS at 20:00hours or 2L of PEG-ASC plus 1L of additional water the day before colonoscopy. Bowel cleansing was evaluated according to the Boston Bowel Preparation Scale (≥6 scores were considered as 'clinical success'), and mucosal visibility according to a 3-point scale. Tolerability, acceptability and compliance were also evaluated. Four hundred and eight patients were randomly allocated to PEG-CS and bisacodyl (n=204, male patient 48%, mean age 59.1years) or PEG-ASC (n=204, male patient 51%, age 59.4years). In the planned per-protocol analysis, the rate of successful preparation was 79.1% following PEG-CS with bisacodyl, and 70% following PEG-ASC (P<0.05). Mucosal visibility was evaluated as optimal in 56.1% in the PEG-CS and bisacodyl and 46.3% in the PEG-ASC group (P<0.05). There were no serious adverse events (AE) in each of the two experimental groups. Two subjects in the PEG-ASC group discontinued the study because of AE. Polyethylene glycol-Citrate-Simethicone in combination with bisacodyl was more effective for bowel cleansing than PEG-ASC for out-patient colonoscopy. Tolerability, safety, acceptability and compliance of the two low-volume bowel preparations were similar.

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A Prospective Audit of the Efficacy, Safety, and Acceptability of Low-volume Polyethylene Glycol (2 L) Versus Standard Volume Polyethylene Glycol (4 L) Versus Magnesium Citrate Plus Stimulant Laxative as Bowel Preparation for Colonoscopy

High-quality video colonoscopy requires adequate preparation of the bowel to ensure both adequate procedure completion rates and polyp detection rates. We sought to examine our practice to determine which bowel preparation cleansed most effectively in our patients. A prospective audit of the efficacy, safety, and acceptability of low-volume polyethylene glycol (2-L Moviprep; Norgine Pharmaceuticals) versus standard volume polyethylene glycol (4-L KleanPrep; Norgine Pharmaceuticals) versus magnesium citrate (Citramag; Sanochemia UK Ltd.) plus stimulant laxative as bowel preparation for colonoscopy. District General Hospital. Patients attending for day case colonoscopy. Not applicable. Overall cleansing grades of preparations used: patient compliance, taste, and acceptability. A prospective audit of patient experience of taking bowel preparation and blinded colonic scoring assessment of bowel cleansing of each of the tested regimes. A total of 258 (female,138; 53.5%) patients were recruited, 91 in the KleanPrep group (F:45, 49.5%), 86 patients in the Moviprep group (female, 45; 52.3%), and 81 in the Senna/Citramag group (female, 44; 54.3%). Significantly more patients were unable to take the prescribed dose of KleanPrep when compared with the other 2 regimes (19.6%; P<0.0001 vs. Moviprep; P<0.0001 vs. Senna/Citramag). A total of 45.65% of patients reported KleanPrep as tasting unpleasant. This was significantly more than both Moviprep (10.47%; P=0.008) and Senna/Citramag (9.88%; P<0.0001). The overall cleansing efficacy across the 3 groups (those with grades A or B) was 73.9%, 74.5%, and 86.5% for KleanPrep, Moviprep, and Senna/Citramag, respectively. In this series Senna/Citramag proved significantly better at bowel cleansing than KleanPrep (P<0.05) and it showed a trend toward better cleansing when compared with Moviprep (P=0.08). Nonrandomized trial. Split-dosing regime for morning and afternoon lists may have confounded results. In summary, low-volume PEG (Moviprep) and Senna/Citramag combination were better tolerated than large volume PEG with Senna/Citramag providing superior mucosal cleansing.