A randomized prospective trial comparing different regimens of oral sodium phosphate and polyethylene glycol–based lavage solution in the preparation of patients for colonoscopy - 16/08/11

Doi : 10.1016/j.gie.2005.09.030

Alaa Rostom, MD, MSc, FRCPC ^⁎, Emilie Jolicoeur, MD, FRCPC, Catherine Dubé, MD, MSc, FRCPC, Sylvie Grégoire, MD, FRCPC, Dilip Patel, MD, FRCPC, Navaaz Saloojee, MD, FRCPC, Catherine Lowe, MD, FRCPC
Current affiliations: Division of Gastroenterology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada

Reprint requests: Alaa Rostom, MD, Gastrointestinal Clinical Research Unit, Division of Gastroenterology, University of Ottawa, A1-Endoscopy Unit, The Ottawa Hospital - Civic Campus, 1053 Carling Ave, Ottawa, Ontario, Canada, K1Y 4E9.

Ottawa, Ontario, Canada

Abstract

Background

Regulatory agencies have warned clinicians regarding the risk of electrolyte abnormalities if more than two 45-mL bottles of oral sodium phosphate (NaP) solution are administered within a 24-hour period.

Objective

To compare the efficacy, safety, and tolerability of different regimens of oral NaP and polyethylene glycol (PEG).

Design

Randomized controlled trial.

Setting

Teaching hospital outpatient endoscopy clinic.

Patients

Two hundred outpatients without comorbidities who underwent routine colonoscopy.

Interventions

Two bottles of NaP, 6, 12, or 24 hours apart; or 4 L PEG.

Main Outcome Measurements

Bowel preparation quality, patient tolerability, and electrolyte changes.

Results

The 12- and 24-hour NaP achieved better cleansing than the 6-hour NaP or PEG. Only 8.5% and 8.3% of patients in the 24- and 12-hour NaP had poor preparations, respectively, compared with 15.6% and 23.4% in the 6-hour NaP and PEG, respectively. The poorer preparation scores with PEG were partly because of a greater amount of colonic fluid. There were no relevant electrolyte changes with PEG, whereas hypokalemia, hypocalcemia, or hyperphosphatemia developed in 5% to 57% of patients on NaP. All regimens were poorly tolerated by patients.

Limitations

The study was likely underpowered to detect small group differences in electrolytes.

Conclusions

A 24- or 12-hour NaP bowel preparation strategy was more effective than NaP 6 hours apart or PEG. PEG use is associated with more residual colonic fluid but represents an alternative to NaP in some clinical situations.

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Plan

Patients and methods

Statistical analysis

Results

Bowel-preparation quality

Laboratory changes

Patient tolerability

Discussion

See CME section; p. 599.
Meeting presentations: Digestive Disease Week, May 15-20, 2004, New Orleans, Louisiana; Canadian Digestive Diseases Week, February 27–March 1, 2004, Banff, Alberta, North American Conference of Gastroenterology Fellows.
Published as an abstract: Jolicoeur E, Rostom A, Gregoire S, et al. A randomized prospective trial comparing different regimens of oral sodium phosphate and polyethylene glycol solution for colonoscopy preparation [abstract]. Can J Gastroenterol 2004;18(A Suppl):A187.