Comparison of two sodium phosphate tablet-based regimens and a polyethylene glycol regimen for colon cleansing prior to colonoscopy: a randomized prospective pilot study

Comparison of oral sodium phosphate tablets and polyethylene glycol lavage solution for colonoscopy preparation: a systematic review and meta-analysis of randomized clinical trials

Objective

To systematically compare the bowel cleaning ability, patient tolerance and safety of oral sodium phosphate tablets (NaPTab) and oral polyethylene glycol electrolyte lavage solution (PEGL) to inform clinical decision making.

Methods

PubMed, Embase, CBM, WanFang Data, CNKI, and VIP databases were searched for studies that used randomized controlled trials (RCTs) to compare the roles of NaPTab and PEGL in bowel preparation before colonoscopy. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias in the included papers. A meta-analysis was performed using RevMan 5.3 software.

Results

A total of 13 RCTs were eligible for inclusion, including 2,773 patients (1,378 and 1,395 cases in the NaPTab and PEGL groups, respectively). Meta-analysis revealed no significant difference in the cleansing quality of the NaPTab and PEGL groups [RR 1.02, 95% CI (0.96-1.08), P = 0.46]. The incidence of nausea was lower in the NaPTab group than in the PEGL group [RR 0.67, 95% CI (0.58-0.76), p < 0.00001]. Patients rated the taste of NaPTab higher than PEGL [RR 1.33, 95% CI (1.26-1.40), P < 0.00001]. Willingness to repeat the treatment was also higher in the NaPTab group than in the PEGL group [RR 1.52, 95% CI (1.28-1.80), P < 0.00001]. Both serum potassium and serum calcium decreased in both groups after the preparation; however, meta-analysis revealed that both minerals decreased more in the NaPTab group than in the PEGL group [MD = 0.38, 95% CI (0.13-0.62), P = 0.006 for serum potassium and MD = 0.41, 95% CI (0.04-0.77), P = 0.03 for serum calcium]. Meanwhile, serum phosphorus increased in both groups after the preparation; however, levels increased more in the NaPTab group than in the PEGL group [MD 4.51, (95% CI 2.9-6.11), P < 0.00001].

Conclusions

While NaP tablets and PEGL were shown to have a similar cleaning effect before colonoscopy, NaP tablets had improved patient tolerance. However, NaP tablets had a strong effect on serum potassium, calcium, and phosphorus levels. For patients with low potassium, low calcium, and renal insufficiency, NaP tablets should be prescribed with caution. For those at high-risk for acute phosphate nephropathy, NaP tablets should be avoided. Given the low number and quality of included studies, these conclusions will require additional verification by large high-quality studies.

Systematic review registration

10.37766/inplasy2023.5.0013, identifier: NPLASY202350013.

Comparing reduced-dose sodium phosphate tablets to 2 L of polyethylene glycol: A randomized study

AIM

To compare the tolerability and quality of bowel cleansing between 2 L polyethylene glycol (PEG) and reduced-dose sodium phosphate (NaP) tablets as a preparation for colonoscopy.

METHODS

Two hundred patients were randomly assigned to the PEG or NaP groups at the same ratio. The NaP group patients took 30 tablets with 2 L of clear liquid, while the PEG group patients took 2L of PEG. Tolerability was assessed by a questionnaire about taste, volume, and the overall impression. The bowel cleansing quality was evaluated by colonoscopists.

RESULTS

Although NaP showed better tolerability in terms of taste, volume and overall impression (P < 0.01, P < 0.01 and P = 0.02, respectively), the overall cleansing quality was better in the PEG group (P < 0.01). A subgroup analysis, stratified by sex and age, indicated that NaP was associated with better tolerability and equivalent bowel cleansing quality in females of < 50 years of age.

CONCLUSION

Despite the better tolerability, the use of 30 NaP tablets with 2 L of clear liquid should be limited due to its lower cleansing quality; however, in certain cases the regimen may deserve consideration, particularly in cases involving young women.

Electrolyte changes after bowel preparation for colonoscopy: A randomized controlled multicenter trial

AIM: To investigate the electrolyte changes between 2-L polyethylene glycol with ascorbic acid 20 g (PEG-Asc) and 4-L PEG solutions.

METHODS: From August 2012 to February 2013, a total of 226 patients were enrolled at four tertiary hospitals. All patients were randomly allocated to a PEG-Asc group or a 4-L PEG. Before colonoscopy, patients completed a questionnaire to assess bowel preparation-related symptoms, satisfaction, and willingness. Endoscopists assessed the bowel preparation using the Boston Bowel Preparation Scale (BBPS). In addition, blood tests, including serum electrolytes, serum osmolarity, and urine osmolarity were evaluated both before and after the procedure.

RESULTS: A total of 226 patients were analyzed. BBPS scores were similar and the adequate bowel preparation rate (BBPS ≥ 6) was not different between the two groups (PEG-Asc vs 4-L PEG, 73.2% vs 76.3%, P = 0.760). Bowel preparation-related symptoms also were not different between the two groups. The taste of PEG-Asc was better (41.1% vs 16.7%, P < 0.001), and the willingness to undergo repeated bowel preparation was higher in the PEG-Asc group (73.2% vs 59.3%, P = 0.027) than in 4-L PEG. There were no significant changes in serum electrolytes in either group.

CONCLUSION: In this multicenter trial, bowel preparation with PEG-Asc was better than 4-L PEG in terms of patient satisfaction, with similar degrees of bowel preparation and electrolyte changes.

Comparison of the efficacy and safety of sodium phosphate tablets and polyethylene glycol solution for bowel cleansing in healthy Korean adults

PURPOSE

Bowel cleansing is generally regarded as time-consuming and unpleasant among patients. Patients commonly state that bowel preparation provokes more discomfort than the actual colonoscopic examination. The purpose of this study was to compare two regimens of sodium phosphate (NaP) tablets versus polyethylene glycol (PEG) solution for bowel preparation in healthy Korean adults.

MATERIALS AND METHODS

This was a single center, prospective, open-label, investigator-blinded, randomized, controlled-pilot study. A total of 62 healthy Korean subjects were randomly assigned to two groups (NaP vs. PEG). Efficacy, safety, and patient-related outcomes, as well as procedural parameters, were evaluated.

RESULTS

Although there were no significant differences in total Ottawa bowel quality score, fluid scores and the rate of adequate bowel preparation were significantly better in the NaP group than the PEG group. Additionally, the NaP group showed better results regarding patient tolerance, satisfaction, preference, and rate of adverse events than the PEG group. Significant fluctuations in specific serum electrolytes were common and of a greater magnitude in the NaP group than the PEG group. However, these abnormalities were transient and did not result in serious complications and side effects.

CONCLUSION

In this study, NaP tablets were shown to be an effective, well-tolerated, and acceptable regimen for bowel preparation. Also, our study suggests that NaP tablets may be safe and can be used as a bowel cleansing agent in healthy adults undergoing elective colonoscopy. Further multicenter, large scale studies are needed to confirm these findings.

Randomized controlled trial comparing Moviprep® and Phosphoral® as bowel cleansing agents in patients undergoing colonoscopy

BACKGROUND

Introducing colonoscopy as part of colorectal cancer screening on a national level, we aimed at evaluating the efficacy of the two most common bowel cleansing agents, Moviprep(®) and Phosphoral(®). Secondly, we evaluated the benefit for the patient and society in terms of sick leave and discomfort.

METHODS

In a single-blinded randomized equivalence trial, Phosphoral(®) (NaP) was compared with Moviprep(®) (2 l polyethylene glycol + ascorbic acid) in patients undergoing colonoscopy due to suspicion of cancer. Patients filled out questionnaires concerning stool consistency, discomfort and number of sick days due to bowel cleansing. Blinded colonoscopists estimated the efficiency of the cleansing using the validated Harefield Cleansing Scale.

RESULTS

Two hundred and sixty-six patients were included 250 of whom underwent full colonoscopy. There was no difference in the percentage of acceptable bowel cleansings in the two groups; however, a significantly higher number of A scores were observed in the Moviprep(®) group (p = 0.028). We found no correlation between stool consistency and outcome of the cleansing and no difference in subjective discomfort during cleansing. Vomiting during cleansing occurred more often in the Phosphoral(®) group (p = 0.002). There was a trend toward a smaller number of sick days in patients who used Moviprep(®) compared with Phosphoral(®).

CONCLUSIONS

Moviprep(®) and Phosphoral(®) provided equally efficient bowel cleansing in 90 % of patients, but Moviprep(®) provided a higher quality of cleansings graded as successful. The two agents were equally tolerated, and no difference was found in the related number of sick days.

Differences in clinical chemistry values according to the use of two laxatives for colonoscopy

OBJECTIVES

Polyethylene glycol-electrolyte lavage solutions (PEG-ELSs) and sodium phosphate formulations (NaPs) are two major colon cleansing laxatives used in preparation for endoscopic examinations of the gastrointestinal tract. PEG-ELSs are osmotically balanced preparations, whereas NaPs are hyperosmotic purgatives. This study aimed to evaluate the effects of these two laxatives on routine chemistry tests.

DESIGN AND METHODS

We retrospectively reviewed 9366 clinical records of patients who had health checkups with or without colonoscopy from July 2010 to June 2011. We compared the values of 19 clinical chemistry parameters in the NaPs group (n=3239) and the PEG-ELSs group (n=1279) with those of controls (without colonoscopy, n=4848).

RESULTS

Compared with controls, the NaPs group had higher mean values of inorganic phosphate, sodium, chloride, creatinine, total protein, AST, and ALT, and lower mean values of calcium and potassium, exceeding acceptable biases. Notably, inorganic phosphate showed the largest % bias (51.14%). In the PEG-ELSs laxative group, higher mean values of inorganic phosphorus, creatinine, uric acid, AST, and total bilirubin and a lower mean value of potassium were observed compared with controls, exceeding acceptable biases. The effects of NaPs on inorganic phosphate, calcium, and electrolyte levels exceeded those of PEG-ELSs.

CONCLUSIONS

PEG-ELSs rather than NaPs are recommended as the first choice for bowel preparation, taking safety concerns and the reliability of laboratory values into account. Blood chemistry data from blood samples drawn after the ingestion of laxatives for colonoscopy should be interpreted with caution.

A pilot study using reduced-volume oral sulfate solution as a preparation for colonoscopy among a Japanese population

BACKGROUND

This pilot study sought to investigate the performance and safety of a reduced-volume oral sulfate solution for use as a bowel-cleansing regimen prior to colonoscopy in a Japanese population.

METHODS

Subjects followed a prescribed split-dose regimen in which the first portion was taken on the evening before colonoscopy and the second portion on the morning of the procedure. To determine the performance of this regimen, the quality of colon cleansing was assessed in each case using a validated four-point scale, and elapsed time to complete the preparation was recorded. Side effects and adverse events were investigated by blood sampling and questionnaire.

RESULTS

The successful preparation rate based on the colon-cleansing score was 97 % (30/31). Mean elapsed time to complete the preparation on the day of colonoscopy was 71 min. Serum levels of indirect bilirubin were significantly increased to abnormal levels following the preparation, although these changes were only transient. Preparation-related symptoms of nausea and vomiting were presented in only one case.

CONCLUSIONS

This pilot study showed the oral sulfate solution-based bowel preparation to be safe, easy, and quick to use for Japanese patients. A larger study is necessary to statistically verify these results.

Comparison of patient acceptance of sodium phosphate versus polyethylene glycol plus sodium picosulfate for colon cleansing in Japanese

BACKGROUND AND AIM

In Japan, patient acceptance of bowel preparation methods before colonoscopy remains unknown. This study was conducted to evaluate the patient acceptance of sodium phosphate (NaP) tablets and polyethylene glycol solution (PEG) with sodium picosulfate.

METHODS

One hundred patients were randomized into one of the following two groups: the NaP tablet first-use group or the PEG with sodium picosulfate first-use group in a crossover design trial. Patient acceptance and incidence of adverse events were evaluated using a questionnaire. Colon-cleansing effectiveness was also evaluated.

RESULTS

Patients' overall impressions of the preparations were significantly different between the NaP tablet (77.9%, 67/86) and PEG with sodium picosulfate (60.5%, 52/86; P = 0.001). Nausea incidence as an adverse event was significantly different between the two regimens (P = 0.03). Colon-cleansing effectiveness was not significantly different between the two regimens.

CONCLUSIONS

The results of this crossover study showed that patient acceptance was similar to those previously reported in a parallel-group comparison. In Japanese patients, preference for and acceptance of NaP tablets was significantly higher than that for PEG with sodium picosulfate solution.

Usefulness of an intensive bowel cleansing strategy for repeat colonoscopy after preparation failure

BACKGROUND

No consensus exists regarding the optimal bowel preparation regimen for patients with poor bowel cleansing at a previous colonoscopy.

OBJECTIVE

We investigated the usefulness of an intensive cleansing regimen for repeat colonoscopy after previous failure of bowel preparation.

DESIGN AND SETTING

A prospective observational study was performed in patients undergoing colonoscopy at a university-based, tertiary referral hospital.

PATIENTS AND INTERVENTION

Outpatients with inadequate preparation at an index colonoscopy were offered a repeat colonoscopy and instructed to follow an intensive preparation regimen consisting of a low-fiber diet for 72 hours, liquid diet for 24 hours, bisacodyl (10 mg) in the evening of the day before the colonoscopy, and a split dose of polyethylene glycol (1.5 L in the evening before and 1.5 L in the morning on the day of the colonoscopy).

MAIN OUTCOME MEASURES

The adequacy of bowel cleansing was assessed according to the Boston Bowel Preparation Scale (0 or 1 on any colon segment = inadequate bowel preparation). Procedural variables, detection rates for polyps and adenomas, compliance, and tolerability of the regimen were assessed. Satisfaction with the regimen was assessed with a 10-point visual analog scale.

RESULTS

Of 83 patients with inadequate bowel preparation at colonoscopy, 51 underwent a second colonoscopy and were analyzed; 46 patients (90.2%) had adequate bowel cleansing at the second colonoscopy, with a mean (SD) total Boston Bowel Preparation Scale score of 7.43 (1.5) and scores of 2.31 (0.6) for the right colon, 2.49 (0.6) for the transverse colon, and 2.63 (0.6) for the left colon. Polyps, flat lesions, or flat lesions proximal to the splenic flexure were found in significantly more patients at the second colonoscopy than at the index colonoscopy. The global satisfaction score was 6.6 (2.7).

LIMITATIONS

The study was limited because of its open observational design, possible patient learning effect for bowel preparation at the repeat colonoscopy, and the inclusion of only outpatients.

CONCLUSIONS

An intensive regimen consisting of a low-fiber diet, bisacodyl, and a split dose of polyethylene glycol can achieve good colon preparation with an improved detection rate for polyps and adenomas in most patients who have had poor bowel cleansing at a previous colonoscopy.

Current techniques in the performance, interpretation, and reporting of CT colonography

The technical objective of computed tomographic colonography (CTC) is to acquire high-quality computed tomography images of the cleansed, well-distended colon for polyp detection. In this article the authors provide an overview of the technical components of CTC, from preparation of the patient to acquisition of the imaging data and basic methods of interpretation. In each section, the best evidence for current practices and recommendations is reviewed. Each of the technical components must be optimized to achieve high sensitivity in polyp detection.