A critical evaluation and a search for the ideal colonoscopic preparation - 17/10/12

Doi : 10.1016/j.clinre.2012.05.015

Manish Arora ^a,^b, Viplove Senadhi ^c,^⁎ , Deepika Arora ^d, Joyce Weinstock ^e, Ethan Dubin ^e, Patrick I. Okolo ^f, Sudhir K. Dutta ^a,^e
^a Division of Gastroenterology, University of Maryland School of Medicine, Baltimore, MD, United States
^b National Institute of Health (NIH), Baltimore/Washington DC, MD, United States
^c Division of Gastroenterology and Hepatology, Indiana Institute for Personalized Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
^d Elmhurst Hospital/Mount Sinai School of Medicine, New York, NY, United States
^e Division of Gastroenterology, Johns Hopkins University/Sinai Hospital of Baltimore, Baltimore, MD, United States
^f Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, United States

Corresponding author. Division of Gastroenterology and Hepatology, Indiana Institute, Regenstrief Suite 4100, 1050 Wishard Blvd, Indianapolis, Indiana, 46204 United States. Tel.: +1 317 278 0403; fax: +1 678 623 5999.

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Summary

Objectives

The aim of this study was to evaluate the efficacy of various bowel preparations in accomplishing colonic cleansing for optimal mucosal visualization during colonoscopy.

Methods

The study included a cohort of 980 patients who underwent colonoscopy at our endoscopy center within the last 3years. All of the study patients were subdivided into four groups. Each group included 245 patients, all receiving a different type of bowel preparation. The bowel preparations used in this study included: magnesium citrate (Group I), a combination of oral sodium phosphate (fleets) and powder PEG-3350 (Group II), powder polyethylene glycol-3350 (PEG-3350 powder for Group III), and oral sodium phosphate (fleets for Group IV). A Colon Prep Score (CPS) was devised to compare the quality of the different bowel preparations used. The colonoscopy results from all of these patients were tabulated and analyzed statistically and expressed as mean±1 standard deviation. Statistical analysis was performed using a one way ANOVA with Holm–Sidak method for intergroup analysis.

Results

Group I patients received magnesium citrate and had a mean CPS±1SD of 3.11±0.91. Group II patients (fleets and powder PEG-3350 combination) achieved a CPS of 3.37±1.16. The patients in Group III (powder PEG-3350) actually showed the highest mean CPS of 3.44±1.12. Group IV patients who used oral sodium phosphate alone reached a mean CPS of 3.23±1.01. Group III patients (powder PEG-3350 only) demonstrated a statistically higher CPS (P<0.0006) in colon cleansing as compared to Group I patients (magnesium citrate). Similarly, Group II patients (oral sodium phosphate and powder PEG-3350 combination) also showed improved colon cleansing statistically (P<0.006) as compared to Group I patients (magnesium citrate).

Conclusions

Overall, all four colon preparations achieved an average CPS greater than 3.0 indicating clinically adequate colonic cleansing. However, powder PEG-3350 alone and in combination with oral sodium phosphate was observed to be statistically superior to magnesium citrate, when used for colon preparation for colonoscopy.

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