Abstract
Background
Four liters or more of orally taken polyethylene glycol solution (PEG) has proved to be an effective large-bowel cleansing method prior to colonoscopy. The problem has been the large volume of fluid and its taste, which is unacceptable to some examinees. We aimed to investigate the effectiveness of 2 l PEG combined with senna compared with 4 l PEG for bowel preparation.
Methods
The design was a single-center, prospective, randomized, investigator-blinded study with parallel assignment, in the setting of the Endoscopy Unit of Umeå University Hospital. Outpatients (n = 490) scheduled for colonoscopy were enrolled. The standard-volume arm received 4 l PEG, and the low-volume arm received 36 mg senna glycosides in tablets and 2 l PEG. The cleansing result (primary endpoint) was assessed by the endoscopist using the Ottawa score. The patients rated the subjective grade of ease of taking the bowel preparation. Analysis was on an intention-to-treat basis.
Results
There were significantly more cases with poor or inadequate bowel cleansing after the low-volume alternative with senna and 2 l PEG (22/203) compared with after 4 l PEG (8/196, p = 0.027). The low-volume alternative was better tolerated by the examinees: 119/231 rated the treatment as easy to take compared with 88/238 in the 4 l PEG arm (p = 0.001).
Conclusions
4 l PEG treatment is better than 36 mg senna and 2 l PEG as routine colonic cleansing before colonoscopy because of fewer failures.
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Acknowledgments
The authors thank the staff at the Endoscopy Unit of Umeå University Hospital and Assistant Professor Ingeborg Waernbaum at the Department of Statistics, Umeå University. Professors P. Naredi and E. Nilsson are acknowledged for comments improving the manuscript. Ali Janbaz, MD has been of great help with quality assessment of the study database. Grant support from the Fund of Gastroenterological Research at the Department of Medicine, Umeå University Hospital and the County Council of Västerbotten is acknowledged.
Disclosures
Authors M.M. Haapamaki, B. Sandzén B, and M. Lindstrom have no conflicts of interest or financial ties to disclose.
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This report refers to registered study NCT00390598 (ClinicalTrials.gov identifier).
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Haapamäki, M.M., Lindström, M. & Sandzén, B. Low-volume bowel preparation is inferior to standard 4 l polyethylene glycol. Surg Endosc 25, 897–901 (2011). https://doi.org/10.1007/s00464-010-1293-6
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DOI: https://doi.org/10.1007/s00464-010-1293-6