Randomized Clinical Trial
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2014; 20(30): 10620-10627
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10620
Efficacy of morning-only 4 liter sulfa free polyethylene glycol vs 2 liter polyethylene glycol with ascorbic acid for afternoon colonoscopy
John M Rivas, Alejandro Perez, Marlow Hernandez, Alison Schneider, Fernando J Castro
John M Rivas, Alison Schneider, Fernando J Castro, Digestive Disease Center, Cleveland Clinic Florida, Weston, FL 33331, United States
Alejandro Perez, Department of Gastroenterology, University of Medicine and Dentistry of New Jersey, Stratford, NJ 08084, United States
Marlow Hernandez, Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL 33331, United States
Author contributions: Castro FJ, Rivas JM, Schneider A and Perez A contributed to the design, acquisition of data, and drafting the article or revising it critically for important intellectual content; Hernandez M, Castro FJ and Rivas JM participated in the statistical analysis and interpretation of data; all authors approved the final version.
Correspondence to: Fernando J Castro, MD, Cleveland Clinic Florida, Digestive Disease Center, 2950 Cleveland Clinic Blvd, Weston, FL 33331, United States. castrof@ccf.org
Telephone: +1-954-6595646 Fax: +1-954-6595647
Received: January 4, 2014
Revised: March 27, 2014
Accepted: April 30, 2014
Published online: August 14, 2014
Abstract

AIM: To compare the bowel cleansing efficacy of same day ingestion of 4-L sulfa-free polyethylene glycol (4-L SF-PEG) vs 2-L polyethylene glycol solution with ascorbic acid (2-L PEG + Asc) in patients undergoing afternoon colonoscopy.

METHODS: 206 patients (mean age 56.7 years, 61% male) undergoing outpatient screening or surveillance colonoscopies were prospectively randomized to receive either 4-L SF-PEG (n = 104) or 2-L PEG + Asc solution (n = 102). Colonoscopies were performed by two blinded endoscopists. Bowel preparation was graded using the Ottawa scale. Each participant completed a satisfaction and side effect survey.

RESULTS: There was no difference in patient demographics amongst groups. 4-L SF-PEG resulted in better Ottawa scores compared to 2-L PEG + Asc, 4.2 vs 4.9 (P = 0.0186); left colon: 1.33 vs 1.57 respectively (P = 0.0224), right colon: 1.38 vs 1.63 respectively (P = 0.0097). No difference in Ottawa scores was found for the mid colon or amount of fluid. Patient satisfaction was similar for both arms but those assigned to 4-L SF-PEG reported less bloating: 23.1% vs 11.5% (P = 0.0235). Overall polyp detection, adenomatous polyp and advanced adenoma detection rates were similar between the two groups.

CONCLUSION: Morning only 4-L SF-PEG provided superior cleansing with less bloating as compared to 2-L PEG + Asc bowel preparation for afternoon colonoscopy. Thus, future studies evaluating efficacy of morning only preparation for afternoon colonoscopy should use 4-L SF-PEG as the standard comparator.

Keywords: Bowel preparation, Colonoscopy, Screening colonoscopy, Colon cancer screening

Core tip: Same day preparation with 4-L sulfa-free polyethylene glycol (4-L SF-PEG) for afternoon colonoscopy is more effective and better tolerated than consumption the day prior. However, no study has compared different bowel preparation solutions administered in their entirety in the morning of an afternoon colonoscopy. We compared the cleansing efficacy and patient satisfaction of same day ingestion of 4-L SF-PEG vs 2-L PEG solution with ascorbic acid (Asc) in patients undergoing afternoon colonoscopy. We found 4-L SF-PEG to provide superior cleansing with less bloating as compared to 2-L PEG + Asc.