Efficacy and tolerability of 2-L polyethylene glycol with ascorbic acid versus sodium picosulfate with magnesium citrate: a randomized controlled trial
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Previous studies comparing 2-L polyethylene glycol (PEG)-based solution with ascorbic acid (PEG/Asc) with sodium picosulfate/magnesium citrate (SP/MC) drew inconclusive results. This study aimed to compare a 2-L-PEG/Asc with SP/MC by split method in bowel cleansing efficacy, tolerability, and safety and to identify factors influencing inadequate bowel preparation.
We performed a prospective randomized, endoscopist-blinded, single-center, controlled trial. The Aronchick scale and Ottawa bowel preparation scale (OBPS) were used to evaluate the bowel cleansing efficacy, and patients’ tolerability and preferences were assessed by questionnaire.
In total, 223 patients were randomized to receive 2-L-PEG/Asc (n = 109) or SP/MC (n = 114).
There was no significant difference in overall bowel cleansing efficacy between the two groups; however, when analyzing by individual segment, mean bowel cleansing efficacy of right colon showed a trend in favor of SP/MC group than in PEG/Asc group (OBPS; 1.55 ± 0.66 vs. 1.74 ± 0.88, P = 0.08). Furthermore, SP/MC was better tolerated than PEG/Asc based on ease of consumption and preference to receive the agents again in the future. Total adverse events were significantly lower in SP/MC group than PEG/Asc group (47.4 vs. 62.4%, P = 0.031). In multivariate analysis, later colonoscopic starting time was the only independent factor predicting inadequate bowel preparation (OR 1.39, 95% CI 1.156–1.692, P = 0.001).
There was no significant difference in overall bowel cleansing efficacy between PEG/Asc and SP/MC; however, SP/MC showed better tolerability and safety profile than PEG/Asc. The independent factor for inadequate bowel preparation was later colonoscopic starting time when applied split method.
KeywordsBowel preparation Polyethylene glycol Ascorbic acid Sodium picosulfate Magnesium citrate
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Committee ASoP, Saltzman JR, Cash BD, Pasha SF, Early DS, Muthusamy VR, Khashab MA, Chathadi KV, Fanelli RD, Chandrasekhara V, Lightdale JR, Fonkalsrud L, Shergill AK, Hwang JH, Decker GA, Jue TL, Sharaf R, Fisher DA, Evans JA, Foley K, Shaukat A, Eloubeidi MA, Faulx AL, Wang A, Acosta RD (2015) Bowel preparation before colonoscopy. Gastrointest Endosc 81(4):781–794. https://doi.org/10.1016/j.gie.2014.09.048 CrossRefGoogle Scholar
- 4.Hassan C, Bretthauer M, Kaminski MF, Polkowski M, Rembacken B, Saunders B, Benamouzig R, Holme O, Green S, Kuiper T, Marmo R, Omar M, Petruzziello L, Spada C, Zullo A, Dumonceau JM (2013) Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 45(2):142–150. https://doi.org/10.1055/s-0032-1326186 CrossRefPubMedGoogle Scholar
- 5.Marmo R, Rotondano G, Riccio G, Marone A, Bianco MA, Stroppa I, Caruso A, Pandolfo N, Sansone S, Gregorio E, D'Alvano G, Procaccio N, Capo P, Marmo C, Cipolletta L (2010) Effective bowel cleansing before colonoscopy: a randomized study of split-dosage versus non-split dosage regimens of high-volume versus low-volume polyethylene glycol solutions. Gastrointest Endosc 72(2):313–320. https://doi.org/10.1016/j.gie.2010.02.048 CrossRefPubMedGoogle Scholar
- 6.Xie Q, Chen L, Zhao F, Zhou X, Huang P, Zhang L, Zhou D, Wei J, Wang W, Zheng S (2014) A meta-analysis of randomized controlled trials of low-volume polyethylene glycol plus ascorbic acid versus standard-volume polyethylene glycol solution as bowel preparations for colonoscopy. PLoS One 9(6):e99092. https://doi.org/10.1371/journal.pone.0099092 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Choi HS, Chung JW, Lee JW, Lim MY, Park DK, Kim YJ, Kwon KA, Kim JH (2016) Polyethylene glycol plus ascorbic acid is as effective as sodium picosulfate with magnesium citrate for bowel preparation: a randomized trial. J Dig Dis 17(4):268–273. https://doi.org/10.1111/1751-2980.12337 CrossRefPubMedGoogle Scholar
- 10.Jeon SR, Kim HG, Lee JS, Kim JO, Lee TH, Cho JH, Kim YH, Cho JY, Lee JS (2015) Randomized controlled trial of low-volume bowel preparation agents for colonic bowel preparation: 2-L polyethylene glycol with ascorbic acid versus sodium picosulfate with magnesium citrate. Int J Color Dis 30(2):251–258. https://doi.org/10.1007/s00384-014-2066-9 CrossRefGoogle Scholar
- 11.Manes G, Amato A, Arena M, Pallotta S, Radaelli F, Masci E (2013) Efficacy and acceptability of sodium picosulphate/magnesium citrate vs low-volume polyethylene glycol plus ascorbic acid for colon cleansing: a randomized controlled trial. Color Dis 15(9):1145–1153. https://doi.org/10.1111/codi.12246 Google Scholar
- 12.Sahebally SM, Burke JP, Chu S, Mabadeje O, Geoghegan J (2015) A randomized controlled trial comparing polyethylene glycol + ascorbic acid with sodium picosulphate + magnesium citrate solution for bowel cleansing prior to colonoscopy. Ir J Med Sci 184(4):819–823. https://doi.org/10.1007/s11845-014-1182-4 CrossRefPubMedGoogle Scholar
- 13.Worthington J, Thyssen M, Chapman G, Chapman R, Geraint M (2008) A randomised controlled trial of a new 2 litre polyethylene glycol solution versus sodium picosulphate + magnesium citrate solution for bowel cleansing prior to colonoscopy. Curr Med Res Opin 24(2):481–488. https://doi.org/10.1185/030079908X260844 CrossRefPubMedGoogle Scholar
- 14.Yoo IK, Lee JS, Chun HJ, Jeen YT, Keum B, Kim ES, Choi HS, Lee JM, Kim SH, Nam SJ, Kang HS, Lee HS, Kim CD, Um SH, Seo YS, Ryu HS (2015) A randomized, prospective trial on efficacy and tolerability of low-volume bowel preparation methods for colonoscopy. Dig Liver Dis. 47 (2):131–137. doi: https://doi.org/10.1016/j.dld.2014.10.019
- 17.Corley DA, Jensen CD, Marks AR, Zhao WK, Lee JK, Doubeni CA, Zauber AG, de Boer J, Fireman BH, Schottinger JE, Quinn VP, Ghai NR, Levin TR, Quesenberry CP (2014) Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 370(14):1298–1306. https://doi.org/10.1056/NEJMoa1309086 CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Menees SB, Kim HM, Elliott EE, Mickevicius JL, Graustein BB, Schoenfeld PS (2013) The impact of fair colonoscopy preparation on colonoscopy use and adenoma miss rates in patients undergoing outpatient colonoscopy. Gastrointest Endosc 78(3):510–516. https://doi.org/10.1016/j.gie.2013.03.1334 CrossRefPubMedGoogle Scholar