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
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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| 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. |
Vol 64 - N° 4
P. 544-552 - ottobre 2006 Ritorno al numero
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