Brief Article
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World J Gastroenterol. Feb 7, 2013; 19(5): 727-735
Published online Feb 7, 2013. doi: 10.3748/wjg.v19.i5.727
Can mosapride citrate reduce the volume of lavage solution for colonoscopy preparation?
Masahiro Tajika, Yasumasa Niwa, Vikram Bhatia, Shinya Kondo, Tsutomu Tanaka, Nobumasa Mizuno, Kazuo Hara, Susumu Hijioka, Hiroshi Imaoka, Koji Komori, Kenji Yamao
Masahiro Tajika, Yasumasa Niwa, Shinya Kondo, Tsutomu Tanaka, Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
Vikram Bhatia, Department of Medical Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Nobumasa Mizuno, Kazuo Hara, Susumu Hijioka, Hiroshi Imaoka, Kenji Yamao, Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
Koji Komori, Department of Gastroenterological surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
Author contributions: Tajika M contributed to study conception and design, analysis and interpretation of the data, drafting of the article; Niwa Y and Yamao K contributed to critical revision of the article for important intellectual content and final approval of the article; Bhatia V contributed to critical revision of the article and drafting of the article; and Tajika M, Kondo S, Tanaka T, Mizuno N, Hara K, Hijioka S, Imaoka H performed the research and collected the data; Komori K contributed data analysis.
Correspondence to: Masahiro Tajika, MD, PhD, Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan. mtajika@aichi-cc.jp
Telephone: +81-52-7626111 Fax: +81-52-7635233
Received: September 6, 2012
Revised: October 10, 2012
Accepted: November 14, 2012
Published online: February 7, 2013
Processing time: 152 Days and 17.1 Hours
Abstract

AIM: To evaluate the possibility of reducing the volume of polyethylene glycol (PEG)-electrolyte solution using adjunctive mosapride citrate for colonoscopy preparation.

METHODS: This was a single-center, prospective, randomized, investigator-blinded, non-inferiority study involving 252 patients of both sexes, aged from 20 to 80 years, scheduled for screening or diagnostic colonoscopy in our department. A total of 126 patients was randomized to receive 1.5 L PEG-electrolyte solution plus 15 mg of mosapride (1.5 L group), and 126 received 2 L PEG-electrolyte solution plus 15 mg of mosapride (2 L group). Patients completed a questionnaire on the acceptability and tolerability of the bowel preparation process. The efficacy of bowel preparation was assessed using a 5-point scale based on the Aronchick scale. The primary end point was adequate bowel preparation rates (score of excellent/good/fair) vs (poor/inadequate). Acceptability and tolerability, as well as disease detection, were secondary end points.

RESULTS: A total of 244 patients was included in the analysis. There were no significant differences between the 2 L and 1.5 L groups in age, sex, body mass index, number of previous colonoscopies, and the preparation method used previously. The adequate bowel preparation rates were 88.5% in the 2 L group and 82.8% in the 1.5 L group [95% lower confidence limit (LCL) for the difference = -14.5%, non-inferiority P = 0.019] in the right colon. In the left colon, the adequate bowel preparation rates were 89.3% in the 2 L group and 81.1% in the 1.5 L group (95% LCL = -17.0%, non-inferiority P = 0.066). Compliance, defined as complete (100%) intake of the PEG solution, was significantly higher in the 1.5 L group than in the 2 L group (96.8% vs 85.7%, P = 0.002). The proportion of abdominal distension (none/mild/moderate/severe) was significantly lower in the 1.5 L group than in the 2 L group (36/65/22/3 vs 58/48/18/2, P = 0.040). Within the subgroup who had undergone colonoscopy previously, a significantly higher number of patients in the 1.5 L group than in the 2 L group felt that the current preparation was easier than the previous one (54.1% vs 28.0%, P = 0.001). The disease detection rate was not significantly different between the two groups.

CONCLUSION: Although the 1.5 L group had better acceptability and tolerability, 15 mg of mosapride may be insufficient to compensate for a 0.5-L reduction of PEG solution.

Keywords: Mosapride citrate; Bowel preparation; Polyethylene glycol-electrolyte solution; Prokinetics; Colonoscopy