Diseases of the Colon & Rectum

, Volume 40, Issue 1, pp 100–104 | Cite as

Cleansing ability and tolerance of three bowel preparations for colonoscopy

  • D. Frommer
Original Contributions


PURPOSE: This study was undertaken to determine whether different regimens using sodium phosphate (NaPh) solutions resulted in better bowel cleansing than polyethylene glycol-salt (PEG) solutions and, if so, why. Side-effects and patient acceptability of the different regimens were also investigated. METHODS: A total of 486 patients requiring colonoscopy were randomly assigned to one of three preparations in a single-blind prospective study. The preparations were as follows: Group A, 3 liters of PEG solution taken at 2 p.m. the day before examination; Group B, 45 ml of NaPh solutions taken at 7 a.m. and 7 p.m. the day before examination; or Group C, 45 ml of NaPh taken at 6 p.m. the day before and at 6 a.m. on the morning of, examination. Cleanliness of the bowel was assessed blindly, and patients were questioned about side-effects and preferences for NaPhvs.PEG. RESULTS: Numbers, ages, and gender distribution of patients in the three groups did not differ significantly from each other. Cleanliness scores for the three groups were 3.34±0.97, 3.22±0.85, and 4.11±0.67 (Group Cvs.Groups A and B,P<0.0005; Group Avs.Group B,P>0.30). Predominance of material in the right side of the colon was found in 13.7, 29.8, and 4.2 percent of Groups A, B, and C, respectively. In the three groups, nausea alone occurred in 3.8, 13.7, and 16.3 percent of patients; vomiting occurred in 0.6, 7.4, and 5.4 percent of patients; and dryness/thirst occurred in 1.9, 17.4, and 20.4 percent of patients, respectively. A total of 80.6 and 82.6 percent of those in Groups B and C who had previously had PEG expressed a preference for taking NaPhP<0.001). CONCLUSIONS: The regimen of Group C is significantly better than the regimens of Groups A or B in bowel cleansing. Regimens of Groups A and B did not differ in efficacy of cleansing. It is the timing of taking NaPh in the regimen of Group C rather than its composition that is responsible for its superior cleansing ability compared with PEG. Overnight deposition of small intestinal material in the right colon is partly responsible for the inferior cleansing ability of regimens that involve taking the solution on the day before colonoscopy. Despite a higher incidence of minor side-effects from NaPh than from PEG, a significantly higher proportion of patients preferred NaPh.

Key words

Bowel preparation Sodium phosphate Polyethylene glycol Gut lavage Colonoscopy 


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  1. 1.
    Vanner SJ, MacDonald PH, Paterson WG, Prentice RS, Da Costa LR, Beck IT. A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (GoLYTELY) in the preparation of patients for colonoscopy. Am J Gastoenterol 1990;85:422–7.Google Scholar
  2. 2.
    Kolts BE, Lyles WE, Achem SR, Burton L, Geller AJ, MacMath T. A comparison of the effectiveness and patient tolerance of oral sodium phosphate, castor oil, and standard electrolyte lavage for colonoscopy or sigmoidoscopy preparation. Am J Gastroenterol 1993;88:1218–23.PubMedGoogle Scholar
  3. 3.
    Polglase AL. Oral sodium phosphate bowel preparation for colonoscopy. Med J Aust 1993;159:491–2.Google Scholar
  4. 4.
    Cohen SM, Wexner SD, Binderow SR,et al. Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods. Dis Colon Rectum 1994;37:689–96.PubMedGoogle Scholar
  5. 5.
    Haroon N, Iber FL. Randomized clinical trial comparing oral sodium phosphate (NaP) with standard polyethylene glycol-based lavage solution (Colyte) in the preparation of patients for colonoscopy [abstract]. Gastroenterolology 1992;102:A13.Google Scholar
  6. 6.
    Marshall JB, Pineda JJ, Barthel JS, King PD. Prospective, randomized trial comparing sodium phosphate solution with polyethylene glycol-electrolyte lavage for colonoscopy preparation. Gastrointest Endosc 1993;39:631–4.PubMedGoogle Scholar
  7. 7.
    Henderson JM, Barnett JL, Elta GH, Nostrant TT, Turgeon DK. Single day oral sodium phosphate laxative preparation for colonoscopy vs intestinal lavage: efficacy and patient tolerance [abstract]. Gastrointest Endosc 1994;40:47.Google Scholar
  8. 8.
    Thompson A, Naidoo P, Crotty B. Bowel preparation for colonoscopy: a randomized prospective trial comparing sodium phosphate and polyethylene glycol in a predominantly elderly population. J Gastroenterol Hepatol 1996;11:103–7.PubMedGoogle Scholar
  9. 9.
    Golub RW, Kerner BA, Wise WE Jr,et al. Colonoscopic bowel preparation—which one? A blinded, prospective, randomized trial. Dis Colon Rectum 1995;38:594–9.PubMedGoogle Scholar
  10. 10.
    Huynh T, Vanner S, Paterson W. Safety profile of 5-h oral sodium phosphate regimen for colonoscopy cleansing: lack of clinically significant hypocalcemia or hypovolemia. Am J Gastroenterol 1995;90:104–7.PubMedGoogle Scholar
  11. 11.
    Moses LE, Emerson JD, Hosseini H, Analysing data from ordered categories. N Engl J Med 1984;311:442–8.PubMedGoogle Scholar
  12. 12.
    Neter J, Wasserman W, Kutner MH. Applied linear statistical models. 2nd ed. Homewood: Richard Irwin, 1985:582–4.Google Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1997

Authors and Affiliations

  • D. Frommer
    • 1
  1. 1.Department of MedicineSt. Vincent's HospitalDarlinghurstAustralia

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