Randomized Controlled Trial of Sodium Phosphate Tablets versus 2 L Polyethylene Glycol Solution for Bowel Cleansing prior to Colonoscopy

Yun Ho Lee; Seong Yeon Jeong; You Sun Kim; Hye Jin Jung; Min Jung Kwon; Cheol Hun Kwak; Song I Bae; Jeong Seop Moon; Ji Won Kim; Su Hwan Kim; Kook Lae Lee

doi:10.4166/kjg.2015.65.1.27

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Lee, Jeong, Kim, Jung, Kwon, Kwak, Bae, Moon, Kim, Kim, and Lee: Randomized Controlled Trial of Sodium Phosphate Tablets versus 2 L Polyethylene Glycol Solution for Bowel Cleansing prior to Colonoscopy

Original Article

Korean J Gastroenterol 2015;65(1):27-34.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.65.1.27

Randomized Controlled Trial of Sodium Phosphate Tablets versus 2 L Polyethylene Glycol Solution for Bowel Cleansing prior to Colonoscopy

Yun Ho Lee, Seong Yeon Jeong, You Sun Kim, Hye Jin Jung, Min Jung Kwon, Cheol Hun Kwak, Song I Bae, Jeong Seop Moon, Ji Won Kim¹, Su Hwan Kim¹, Kook Lae Lee¹

Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

¹Departments of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea

Correspondence to: You Sun Kim, Division of Gastroenterology, Department of Internal Medicine, Inje University Seoul Paik Hospital, 9 Mareunnae-ro, Jung-gu, Seoul 100-032, Korea. Tel: +82-2-2270-0012, Fax: +82-2-2279-4021, E-mail: yousunk69@korea.com

Received 3 September 201417 October 2014 Accepted 6 November 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Performance of polyethylene glycol solution (PEG) is often unsatisfactory as bowel preparation agent for colonoscopy. In order to provide equivalent efficacy with better patient tolerance, sodium phosphate tablet (SPT) has been developed. This study was carried out to compare the efficacy and compliance of two bowel preparation methods: PEG with ascorbic acid (PEGA) vs. SPT preparation.

Methods

A multicenter, randomized controlled trial was performed. Primary efficacy variable was overall quality of colon cleansing assessed by Boston bowel preparation scale (BBPS) during colonoscopy. Patient's satisfaction and adverse events were evaluated by means of symptom questionnaire completed by each patient immediately before colonoscopy.

Results

A total of 189 patients were randomly assigned to undergo pre-colonoscopic bowel preparation with either SPT (n=96) or PEGA (n=93). Overall BBPS score was 8.3±1.12 in the SPT group and 8.4±0.96 in the PEGA group (p=0.441). Among the 189 patients, 90 had polyps (47.6%) and 50 had adenomas (26.5%). The polyp/adenoma detection rate was 54.2% (n=52)/27.1% (n=26) for SPT group and 40.9% (n=38)/25.8% (n=24) for PEGA group (p=0.079 and 0.790, respectively). More number of patients were unable to take the prescribed dose of PEGA compared with the SPT regimen (8.6% vs. 2.0%, p=0.045). Overall satisfaction score was 7.9±1.63 in the SPT group and 7.4±1.53 in the PEGA group (p=0.022).

Conclusions

Degree of colon preparation, polyp/adenoma detection rate and adverse effect were similar between SPT group and PEGA group. Patient compliance and satisfaction were greater in the SPT group.

Keywords: Sodium phosphate, Polyethylene glycols, Bowel preparation solutions, Colonoscopy

References

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Fig. 1.

Comparison of patient's satisfaction. (A) Patients preferred NaP tablet rather than PEGA. (B) There is no significant difference between groups for taste and quantity (p=0.864, p=0.488). ∗p=0.022. NaP, sodium phosphate; PEGA, polyethylene glycol with ascorbic acid.

Fig. 2.

Detection rate of polyp and adenoma between the two groups. There is no significant difference between two groups in polyp detection rate (p=0.079) and adenoma detection rate (p=0.790). NaP, sodium phosphate; PEGA, polyethylene glycol with ascorbic acid.

Table 1.

Baseline Characteristics

Characteristic	NaP tablet (n=96)	PEGA (n=93)	p-value
Age (yr)	44.1±9.8	45.4±8.7	0.326
Gender			0.746
Male	59 (61.5)	55 (59.1)
Female	37 (38.5)	38 (40.9)
BMI (kg/m²)	24.5±3.2	23.5±2.7	0.028
Prior colonoscopy	12 (12.5)	21 (22.6)	0.069
History of abdominal operation	57 (59.4)	50 (53.8)	0.439
Average stool frequency per week	7.58	7.06	0.623
Indications for colonoscopy			0.520
Screening	35 (36.5)	43 (46.2)
Bowel habit change	22 (22.9)	17 (18.3)
Abdominal pain	15 (15.6)	13 (14)
Hematochezia	12 (12.5)	9 (9.7)
Anemia	0 (0)	2 (2.2)
Weight loss	1 (1)	0 (0)
Surveillance after polypectomy	11 (11.5)	9 (9.7)

Values are expressed as n, mean±SD, or n (%).

NaP, sodium phosphate; PEGA, polyethylene glycol with ascorbic acid.

Table 2.

Procedural Time and Bowel Preparation

Variable	NaP tablet	PEGA	p-value
Procedural time
Cecal intubation time (min)	8.7±4.91	9.4±7.77	0.460
Withdrawal time (min)	12.1±5.891	11.3±5.63	0.310
Bowel preparation (BBPS score)
Ascending colon	2.6±0.47	2.7±0.41
Transverse colon	2.8±0.45	2.8±0.40
Descending colon	2.8±0.46	2.8±0.40
Total	8.3±1.12	8.4±0.96	0.441

Values are expressed as mean±SD.

NaP, sodium phosphate; PEGA, polyethylene glycol with ascorbic acid; BBPS, Boston bowel preparation scale.

Table 3.

Side Effects Related to Bowel Preparation

Side effect	NaP tablet	PEGA	p-value
Nausea	16 (16.7)	15 (16.1)
Vomiting	3 (3.1)	3 (3.2)
Abdominal pain	2 (2.1)	3 (3.2)
Dizziness	5 (5.2)	4 (4.3)
Abdominal distension	n 3 (3.1)	5 (5.4)
Sleep disturbance	1 (1.0)	0 (0)
Total	30 (31.2)	30 (32.2)	0.279

Values are expressed as n (%).

NaP, sodium phosphate; PEGA, polyethylene glycol with ascorbic acid.

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ORCID iDs: You Sun Kim
https://orcid.org/http://orcid.org/0000-0002-5156-3458
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