Split-dose Bowel Preparation for Colonoscopy: 2 Liters Polyethylene Glycol with Ascorbic Acid versus Sodium Picosulfate versus Oral Sodium Phosphate Tablets

Seok Won Lee; Chang Seok Bang; Tae Young Park; Ki Tae Suk; Gwang Ho Baik; Dong Joon Kim

doi:10.4166/kjg.2017.70.2.89

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Lee, Bang, Park, Suk, Baik, and Kim: Split-dose Bowel Preparation for Colonoscopy: 2 Liters Polyethylene Glycol with Ascorbic Acid versus Sodium Picosulfate versus Oral Sodium Phosphate Tablets

Original Article

Korean J Gastroenterol 2017;70(2):89-95.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.70.2.89

Split-dose Bowel Preparation for Colonoscopy: 2 Liters Polyethylene Glycol with Ascorbic Acid versus Sodium Picosulfate versus Oral Sodium Phosphate Tablets

Seok Won Lee, Chang Seok Bang, Tae Young Park, Ki Tae Suk, Gwang Ho Baik, Dong Joon Kim

Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea

Correspondence to: Chang Seok Bang, Division of Gastroenterology, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 24253, Korea. Tel: +82-33-240-5000, Fax: +82-33-241-8064, E-mail: csbang@hallym.ac.kr

Received 19 January 2017 Accepted 21 April 2017

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

Adequate bowel preparation is an essential factor affecting the visibility of colonic mucosa and safety of related therapeutic interventions. The aim of this study was to assess the efficacy, tolerability, and safety of three bowel preparation agents –2 L polyethylene glycol with ascorbic acid (PEGA), sodium picosulfate magnesium citrate (SPMC), and oral sodium phosphate tablet (NaP)– for morning colonoscopy.

Methods

Here, we analyzed the medical records of patients who had taken bowel preparation agents using the split-dose method and undergone colonoscopy in a single hospital. The efficacy of bowel preparation agents was evaluated using the Ottawa bowel preparation assessment tool. The safety and tolerability of the agents were assessed by measuring the renal function and electrolytes prior to and after the procedure as well as by assessing the self-reported questionnaire.

Results

Of the 365 patients (PEGA:163, SPMC: 93, NaP: 109), 98.6% ingested more than 90% of the agents. NaP showed an inferior cleansing efficacy, and serum phosphate elevation was significantly higher in the NaP group. However, the satisfaction score was lowest in the PEGA group. Age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.92–0.99, p=0.04) and preparation agents (OR of PEGA versus NaP 5.0, 95% CI 2.28–10.97, p<0.001) (OR of SPMC versus NaP 2.73, 95% CI 1.22–6.08, p=0.01) were independently associated with bowel preparation success.

Conclusions

According to our analysis, NaP showed an inferior cleansing efficacy compared with PEGA and SPMC, which may be attributed to the complex administration method and lower water intake. However, large-volume ingestion remains unsatisfactory for patients. Detailed bowel preparation instructions could enhance bowel cleansing efficacy.

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

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Fig. 1.

Flow diagram of study. PEGA, polyethylene glycol+ascorbic acid; SPMC, sodium picosulfate magnesium citrate; NaP, sodium phosphate.

Table 1.

Clinical Characteristics of Total Enrolled Population

Characteristics	PEGA (n=163)	SPMC (n=93)	NaP (n=109)	p-value
Age	49.6±9.8	50.7±9.4	47.6±8.3	0.06
Sex				0.27
Male	101 (62.0)	56 (60.2)	57 (52.3)
Female	62 (38.0)	37 (39.8)	52(47.7)
Smoking	33 (20.2)	24 (25.8)	21 (19.3)	0.47
Alcohol	55 (33.7)	36 (38.7)	50 (45.9)	0.13
DM	15 (9.2)	8 (8.6)	2 (1.8)	0.05
HTN	44 (27.0)	24 (25.8)	18 (16.5)	0.12
BMI	24.5±3.1	24.0±3.3	23.8±3.3	0.22

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

PEGA, polyethylene glycol+ascorbic acid; SPMC, sodium picosulfate magnesium citrate; NaP, sodium phosphate; DM, diabetes mellitus; HTN, hypertension; BMI, body mass index.

Table 2.

Cleansing Efficacy of Bowel Preparation Agents

Component of Ottawa bowel preparation scale	PEGA (n=163)	SPMC (n=93)	NaP (n=109)	p-value
Right colon	0.93±0.69	0.97±0.84	1.51±1.07	<0.001 ^a
Mid colon	1.01±0.56	1.05±0.81	1.34±0.93	0.005 ^b
Rectosigmoid colon	0.56±0.64	0.69±0.88	1.04±0.99	<0.001 ^c
Colonic fluid	1.06±0.37	1.09±0.41	1.05±0.48	0.77
Total score	3.57±1.70	3.82±2.55	4.93±2.96	<0.001 ^d

Values are presented as mean±standard deviation.

PEGA, polyethylene glycol+ascorbic acid; SPMC, sodium picosulfate magnesium citrate; NaP, sodium phosphate.

^a Significant difference between PEGA and NaP (p<0.001), and between SPMC and NaP (p<0.001)

^b Significant difference between PEGA and NaP (p=0.001), and between SPMC and NaP (p=0.02)

^c Significant difference between PEGA and NaP (p<0.001), and between SPMC and NaP (p=0.008)

^d Significant difference between PEGA and NaP (p<0.001), and between SPMC and NaP (p=0.003).

Table 3.

Safety Profile of Bowel Preparation Agents

	PEGA (n=92)	SPMC (n=72)	NaP (n=83)	p-value
Na (mmol/L)	0.40	−0.33	0.81	0.91
Cl (mmol/L)	1.29	−0.80	−0.11	0.03^a
P (mg/dL)	−0.07	0.07	3.85	<0.001^b
Ca (mg/dL)	0.07	0.14	−0.35	<0.001^c
Cr (mg/dL)	0.01	0.01	0.01	0.91
eGFR (mL/min)	−1.10	−0.79	−0.97	0.98

The mean difference between pre & post-bowel preparation of serum electrolyte and eGRF.

PEGA, polyethylene glycol+ascorbic acid; SPMC, sodium picosulfate magnesium citrate; NaP, sodium phosphate; eGFR, estimated glomerular filtration rate.

^a Significant difference between PEGA and SPMC (p=0.03)

^b Significant difference between PEGA and NaP (p<0.001), and between SPMC and NaP (p<0.001)

^c Significant difference between PEGA and NaP (p<0.001), and between SPMC and NaP (p<0.001).

Table 4.

Tolerability of Bowel Preparation Agents

	PEGA (n=163)	SPMC (n=93)	NaP (n=109)	p-value
Could not intake all the preparation agents	3 (1.8)	1 (1.1)	1 (0.9)	0.86
Satisfaction score	7.29±2.00	8.25±1.71	8.12±1.60	<0.001^a
Refuse to take the same preparation agent in the future	48 (29.4)	16 (17.2)	17 (15.6)	0.01

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

PEGA, polyethylene glycol+ascorbic acid; SPMC, sodium picosulfate magnesium citrate; NaP, sodium phosphate.

^a Significant difference between PEGA and SPMC (p<0.001), and between PEGA and NaP (p=0.001).

Table 5.

Multivariable Logistic Regression Analysis Assessing the Associated Factors of Successful Bowel Preparation (Ottawa bowel preparation scale score 7 or less)

Variables	p-value	OR (95% CI)
Age	0.04	0.96 (0.92–0.99)
Sex	0.06	1.93 (0.98–3.91)
Bowel preparation agents
PEGA	<0.001	5.00 (2.28–10.97)
SPMC	0.01	2.73 (1.22–6.08)
NaP	Control
Alcohol	0.83	1.09 (0.50–2.33)
Smoking	0.40	1.47 (0.60–3.62)
DM	0.59	1.54 (0.33–7.21)
HTN	0.92	0.96 (0.44–2.10)
BMI	0.30	0.95 (0.86–1.05)

OR, odds ratio; CI, confidence interval; PEGA, polyethylene glycol+ ascorbic acid; SPMC, sodium picosulfate magnesium citrate; NaP, sodium phosphate; DM, diabetes mellitus; HTN, hypertension; BMI, body mass index.

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