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Split-dose Bowel Cleansing With Picosulphate Is Safe and Better Tolerated Than 2-l Polyethylene Glycol Solution

Split-dose Bowel Cleansing With Picosulphate Is Safe and Better Tolerated Than 2-l Polyethylene Glycol Solution

Elisabeth M H Mathus-Vliegen, Karin van der Vliet, Inge J Wignand-van der Storm, John S Stadwijk

Eur J Gastroenterol Hepatol. 2018 Jul;30(7):709-717.

PMID: 29642094

Abstract:

Background:
In physically less fit patients and patients requiring repeated exams, adequate bowel preparation for colonoscopy remains problematic, particularly because patients need to drink large volumes of unpleasant-tasting fluids. A further concern is potential unwarranted fluid shifts.
Aims:
This study aimed to compare the safety and burden of a small-volume sodium picosulphate/magnesium citrate preparation (SPS-MC) with a 2-l ascorbic-acid-enriched polyethylene glycol solution plus bisacodyl pretreatment (PEG-Asc+B).
Patients and methods:
Patients referred for colonoscopy were randomized to SPS-MC or PEG-Asc+B administered as a split-dose regimen. Patients received advice on the recommended 4-l SPS-MC and 2-l PEG-Asc+B fluid intake. Safety was assessed by blood sampling before and after the preparation and during a 30-day follow-up period. A questionnaire assessed tolerability and perceived burden of the preparation.
Results:
A total of 341 patients underwent colonoscopy. Blood sampling showed a slight but significant decrease in sodium, chloride and osmolality and increase in magnesium in the SPS-MC group and a decrease in bicarbonate in the PEG-Asc+B group. Hyponatraemia and hypermagnesaemia without clinical signs were observed in 16 (14 SPS-MC) and 13 SPS-MC patients, respectively. Patients reported significantly fewer physical complaints and a significantly higher completion rate with SPS-MC. Patients receiving SPS-MC rated the intake as being easier and better tasting. In the event of a repeat colonoscopy, 59.7% of patients in the PEG-Asc+B and 93.6% of patients in the SPS-MC group would opt for the same preparation again.
Conclusion:
Despite electrolyte shifts, both SPS-MC and PEG-Asc+B appeared clinically safe. From a patient's perspective, a small-volume preparation formula such as SPS-MC is preferred, resulting in fewer physical complaints and greater ease of intake.

Chemicals Related in the Paper:

Catalog Number	Product Name	Structure	CAS Number	Price
AP25322683-P	Polyethylene glycol solution		25322-68-3	Price
TIT9326	Solvent MC			Price

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