Comparative Study on Bowel Preparation Efficacy of Ascorbic Acid Containing Polyethylene Glycol by Adding Either Simethicone or 1 L of Water in Health Medical Examination Patients: A Prospective Randomized Controlled Study

Se Hwan Yeo; Jae Hoon Kwak; Yeo Un Kim; Tae Ho Kwon; Jeong Bae Park; Jun Hyung Park; Yong Kook Lee; Yun Jeong Lim; Chang Heon Yang

doi:10.4166/kjg.2016.67.4.189

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Yeo, Kwak, Kim, Kwon, Park, Park, Lee, Lim, and Yang: Comparative Study on Bowel Preparation Efficacy of Ascorbic Acid Containing Polyethylene Glycol by Adding Either Simethicone or 1 L of Water in Health Medical Examination Patients: A Prospective Randomized Controlled Study

Original Article

Korean J Gastroenterol 2016;67(4):189-197.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.67.4.189

Comparative Study on Bowel Preparation Efficacy of Ascorbic Acid Containing Polyethylene Glycol by Adding Either Simethicone or 1 L of Water in Health Medical Examination Patients: A Prospective Randomized Controlled Study

Se Hwan Yeo, Jae Hoon Kwak, Yeo Un Kim, Tae Ho Kwon, Jeong Bae Park, Jun Hyung Park, Yong Kook Lee, Yun Jeong Lim¹, Chang Heon Yang

Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea

¹Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Dongguk University College of Medicine, Korea

Correspondence to: Chang Heon Yang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, 87 Dongdae-ro, Gyeongju 38067, Korea. Tel: +82-54-770-8206, Fax: +82-54-770-8378, E-mail: chhyang@dongguk.ac.kr

Received 14 January 2016 Revised 2 March 2016 Accepted 23 March 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

There are no studies that looked into the bubble eliminating efficacy of polyethylene glycol with ascorbic acid (PEGA), which has been one of the shortcomings of polyethylene glycol (PEG). In this study, we compared newly introduced PEGA regimen by adding either simethicone or 1 L of water.

Methods

A prospective randomized controlled study was carried out at Dongguk Universtiy Gyeongju Hospital from July 2014 to September 2014. A total of 90 patients were randomly assigned to 3 groups; PEGA group (n=30) which served as control, simethicone addition group (n=30) to which simethicone 400 mg was additionally prescribed, and water addition group (n=30) to whom additional 1 L of water was given. Cleansing effectiveness, gas elimination efficacy, side effects, and patient satisfaction were compared between the groups.

Results

PEGA group demonstrated the highest cleansing effectiveness, but there was no statistically significant difference among the groups. Simethicone addition group showed significantly lesser amount of bubbles than the other groups (2.57±2.05 vs. 1.10±1.83 vs. 2.60±2.84, p=0.017). The rates of side effects in each group were 20.00% vs. 16.77% vs. 53.33%. Water addition group had significantly more side effects than the PEGA group and the simethicone addition group (p=0.003). The patient satisfaction score of each group was 3.37±0.85 vs. 3.73±0.74 vs. 3.20±0.66 with simethicone addition group showing significantly higher satisfaction than water addition group (p=0.020).

Conclusions

PEGA bowel preparation agent showed satisfactory bowel cleansing despite the decrease in dosage, and addition of simethicone resulted in better bubble elimination.

Keywords: Colonoscopy, Bowel preparation solutions

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Fig. 1.

Aronchick Bowel Preparation Scale (ABBS) score.

Fig. 2.

Boston Bowel Preparation Scale (BBPS) score.

Fig. 3.

Satisfaction of bowel preparation methods. We investigated the satisfaction with a five-point scale, extremely dissatisfied with one point and very satisfied with 5 points.

Table 1.

Inclusion and Exclusion Criteria

Inclusion criteria

Adult aged 30–70 years of age scheduled for health screening colonoscopy who received a written consent

Exclusion criteria

Pregnancy

Massive ascites

Renal insufficiency

Congestive heart failure

Myocardial infarction within 6 months

Coagulopathy

History of colonic surgery

Colonic obstruction

History of other laxative agent use within 1 week

Refusal to participate in the study

Table 2.

Aronchick Bowel Preparation Scale (ABPS)

Grade	Points	Description
Excellent	1	Small amount of clear liquid with clear mucosa seen; more than 95% mucosa seen
Good	2	Small amount of turbid fluid without feces not interfering with examination; more than 90% mucosa seen
Fair	3	Moderate amount of stool that can be cleared with suctioning permitting adequate evaluation of entire colonic mucosa; more than 90% mucosa seen
Poor	4	Inadequate but examination completed; enough feces or turbid fluid to prevent a reliable examination; less than 90% mucosa seen
Inadequate	5	Re-preparation required; large amount of fecal residue precludes a complete examination

Table 3.

Boston Bowel Preparation Scale (BBPS)

Points	Description
0	Unprepared colon segment with stool that cannot be cleared
1	Portion of mucosa in segment seen after cleaning, but other areas not seen because of retained material
2	Minor residual material after cleaning, but mucosa of segment generally well seen
3	Entire mucosa of segment well seen after cleaning

BBPS total score is calculated by adding the scores of the right, transverse, and left colon segments. The total BBPS score ranges from 0 (very poor) to 9 (excellent).

Table 4.

Grading of Intraluminal Air Bubbles

Grade	Interpretation	Point
Grade 0	No or minimal scattered bubbles	0
Grade 1	Bubbles covering at least half the luminal diameter	1
Grade 2	Bubbles covering the circumference of the lumen	2
Grade 3	Bubbles filling the entire lumen	3

Table 5.

Baseline Characteristics of the Study Groups

Characteristic	PEGA (n=30)	Simethicone addition (n=30)	Water addition (n=30)	p-value
Age (yr)	47.53±8.76	50.43±8.93	46.00±7.85	NS
Gender				NS
Male	20 (66.7)	19 (63.3)	17 (56.7)
Female	10 (33.3)	11 (36.7)	13 (43.3)
Smoking history				NS
Non-smoker	13 (43.3)	17 (56.7)	20 (66.7)
Smoker	5 (16.7)	6 (20.0)	5 (16.7)
Ex-smoker	12 (40.0)	7 (23.3)	5 (16.7)
Diabetes mellitus	1 (3.3)	2 (6.7)	0 (0)	NS
Hypertension	4 (13.3)	3 (10.0)	0 (0)	NS
BMI (kg/m²)	23.0±2.53	23.4±3.26	23.8±2.74	NS
Chronic constipation	0 (0)	0 (0)	0 (0)	NS
History of IBS	0 (0)	0 (0)	0 (0)	NS
History of colonic surgery	0 (0)	0 (0)	0 (0)	NS

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

PEGA, polyethylene glycol 2 L+ascorbic acid+water 1 L; IBS, irritable bowel syndrome.

Table 6.

Colonoscopic Results and Findings of the Study Groups

Colonoscopic results and findings	PEGA (n=30)	Simethicone addition (n=30)	Water addition (n=30)	p-value
Normal	16 (53.3)	15 (50.0)	20 (66.7)	NS
Polyps	12 (40.0)	12 (40.0)	9 (30.0)	NS
Cancer	0 (0)	0 (0)	0 (0)	NS
Colitis	1 (3.3)	2 (6.3)	0 (0)	NS
Diverticulum	1 (3.3)	1 (3.3)	1 (3.3)	NS
Others	0 (0)	0 (0)	0 (0)	NS

Values are presented as n (%).

PEGA, polyethylene glycol 2 L+ascorbic acid+water 1 L.

Table 7.

Colonoscopic Results, Cleansing Effects and Air Bubbles between the Study Groups

	PEGA (n=30)	p-value	Simethicone addition (n=30)	p-value	Water addition (n=30)	p-value
Cleansing effect according to ABPS	2.50±0.50	NS	2.59±0.78	NS	2.74±0.85	NS
Cleansing effect according to BBPS
Right colon	1.77±0.81	NS	2.03±0.68	NS	1.68±0.65	NS
Transverse colon	1.97±0.32	NS	1.86±0.58	NS	1.68±0.59	NS
Left colon	1.72±0.64	0.002	2.17±0.64	0.002	1.61±0.55	0.002
Total score	5.62±1.52	0.030	5.90±1.15	0.030	4.97±1.44	0.030
Degree of air bubbles
Rectosigmoid colon	0.57±0.97	NS	0.33±0.80	NS	30±0.79	NS
Descending colon	0.33±0.61	NS	0.20±0.61	NS	0.53±0.78	NS
Transverse colon	0.90±0.85	0.022	0.30±0.84	0.022	0.63±0.89	NS
Ascending colon	0.47±0.73	NS	0.23±0.68	NS	0.53±0.78	NS
Cecum	0.30±0.54	NS	0.30±0.18	0.001	0.60±0.81	0.001
Total mean	2.57±2.05	0.017	1.10±1.83	0.017	2.60±2.84	0.017

Values are presented as mean±SD.

PEGA, polyethylene glycol 2 L+ascorbic acid+water 1 L; ABPS, Aronchick Bowel Preparation Scale; BBPS, Boston Bowel Preparation Scale.

Table 8.

Comparison of Side Effects of the Study Groups

	PEGA (n=30)	p-value	Simethicone addition (n=30)	p-value	Water addition (n=30)	p-value
None	24 (80.0)	NS	25 (83.3)	NS	14 (46.7)	0.003
Reflux	0 (0)	NS	0 (0)	NS	3 (10.0)	0.010
Vomiting	3 (10.0)	NS	0 (0)	NS	1 (3.3)	NS
Nausea	1 (3.3)	NS	3 (10.0)	NS	5 (16.7)	NS
Abdominal pain	2 (6.7)	NS	2 (6.7)	NS	7 (23.3)	0.020

Values are presented as n (%).

PEGA, polyethylene glycol 2 L+ascorbic acid+water 1 L.

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