Brief Article
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World J Gastrointest Endosc. Sep 16, 2013; 5(9): 433-439
Published online Sep 16, 2013. doi: 10.4253/wjge.v5.i9.433
Same-day 2-L PEG-citrate-simethicone plus bisacodyl vs split 4-L PEG: Bowel cleansing for late-morning colonoscopy
Annalisa de Leone, Darina Tamayo, Giancarla Fiori, Davide Ravizza, Cristina Trovato, Giuseppe De Roberto, Linda Fazzini, Marco Dal Fante, Cristiano Crosta
Annalisa de Leone, Darina Tamayo, Giancarla Fiori, Davide Ravizza, Cristina Trovato, Giuseppe De Roberto, Cristiano Crosta, Division of Endoscopy, European Institute of Oncology, 20141 Milan, Italy
Linda Fazzini, Marco Dal Fante, Gastroenterology and Endoscopy Department, Casa di Cura S. Pio X, 20159 Milan, Italy
Author contributions: Dal Fante M and Crosta C have designed the research and approved the manuscript; de Leone A, Fiori G, Ravizza D, De Roberto G and Fazzini L performed the research; de Leone A, Tamayo D and Trovato C have interpreted data and have written the article.
Correspondence to: Cristina Trovato, MD, Division of Endoscopy, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. cristna.trovato@ieo.it
Telephone: +39-2-94372680 Fax: +39-2-94379220
Received: June 5, 2013
Revised: July 26, 2013
Accepted: August 17, 2013
Published online: September 16, 2013
Abstract

AIM: To evaluate the efficacy, tolerability, acceptability and feasibility of bisacodyl plus low volume polyethyleneglycol-citrate-simeticone (2-L PEG-CS) taken the same day as compared with conventional split-dose 4-L PEG for late morning colonoscopy.

METHODS: Randomised, observer-blind, parallel group, comparative trial carried out in 2 centres. Out patients of both sexes, aged between 18 and 85 years, undergoing colonoscopy for diagnostic investigation, colorectal cancer screening or follow-up were eligible. The PEG-CS group received 3 bisacodyl tablets (4 tablets for patients with constipation) at bedtime and 2-L PEG-CS in the morning starting 5 h before colonoscopy. The control group received a conventional 4-L PEG formulation given as split regimen; the morning dose was taken with the same schedule of the low volume preparation. The Ottawa Bowel Preparation Scale (OBPS) score was used as the main outcome measure.

RESULTS: A total of 164 subjects were enrolled and 154 completed the study; 78 in the PEG-CS group and 76 in the split 4-L PEG group. The two groups were comparable at baseline. The OBPS score in the PEG-CS group (3.09 ± 2.40) and in the PEG group (2.39 ± 2.55) were equivalent (difference +0.70; 95%CI: -0.09-1.48). This was confirmed by the rate of successful bowel cleansing in the PEG-CS group (89.7%) and in the PEG group (92.1%) (difference -2.4%; 95%CI: -11.40- 6.70). PEG-CS was superior in terms of mucosa visibility compared to PEG (85.7% vs 72.4%, P = 0.042). There were no significant differences in caecum intubation rate, time to reach the caecum and withdrawal time between the two groups. The adenoma detection rate was similar (PEG-CS 43.6% vs PEG 44.7%). No serious adverse events occurred. No difference was found in tolerability of the bowel preparations. Compliance was equal in both groups: more than 90% of subjects drunk the whole solution. Willingness to repeat the same bowel preparations was about 90% for both regimes.

CONCLUSION: Same-day PEG-CS is feasible, effective as split-dose 4-L PEG for late morning colonoscopy and does not interfere with work and daily activities the day before colonoscopy.

Keywords: Bowel preparation, Polyethyleneglycol, Simethicone, Ottawa Bowel Preparation Scale, Colonoscopy

Core tip: The timing of bowel preparation is fundamental for high quality colonoscopy and also for patient satisfaction. Split-dose preparation improves the rate of adequate cleansing and patient compliance. This study shows that the same-day low volume polyethyleneglycol-citrate-simeticone (PEG-CS) plus bisacodyl tablets is feasible, and as effective as split 4-L PEG. The low volume bowel preparation taken the same day of the exam may be an attractive option for late morning colonoscopy as it reduces the overall time for bowel preparation with no loss of work time and impact on daily activities the day before the exam.