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Canadian Journal of Gastroenterology
Volume 25, Issue 12, Pages 657-662
Original Article

A Randomized Controlled Trial of Four Precolonoscopy Bowel Cleansing Regimens

Dina Kao,1 Eoin Lalor,1 Gurpal Sandha,1 Richard N Fedorak,1 Bloeme van der Knoop,2 Stieneke Doornweerd,2 Harmke van Kooten,3 Eline Schreuders,3 William Midodzi,4 and Sander Veldhuyzen van Zanten1

1Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
2Free University of Amsterdam, Amsterdam, The Netherlands
3Erasmus University, Rotterdam, The Netherlands
4Patient Research Centre, Memorial University, St John’s, Newfoundland and Labrador, Canada

Received 31 March 2011; Accepted 29 July 2011

Copyright © 2011 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: The ideal bowel cleansing regimen for colonoscopy has yet to be determined.

OBJECTIVE: To compare the cleansing efficacy, and patient tolerability and safety of four bowel preparation regimens.

METHODS: A total of 834 patients undergoing outpatient colonoscopy were randomly assigned to one of four regimens: 4 L polyethylene glycol (PEG); 2 L PEG + 20 mg bisacodyl; 90 mL of sodium phosphate (NaP); or two sachets of a commercially available bowel cleansing solution (PSMC) + 300 mL of magnesium citrate (M). The primary outcome measure was cleansing efficacy, which was scored by blinded endoscopists using the Ottawa Bowel Preparation Scale. Secondary outcome measures were bowel preparation quality according to time of colonoscopy, and patient tolerability and safety.

RESULTS: The mean total cleansing score was significantly worse in the NaP group compared with the other three groups (P<0.0001). The mean cleansing scores were worse in patients who underwent morning versus afternoon colonoscopy, a finding that was consistent in all four groups. PSMC + M was the best tolerated regimen. No clinically significant mean changes in creatinine or electrolyte levels were identified, although a significantly higher proportion of patients in the NaP group developed hypokelemia (P<0.0001).

CONCLUSIONS: 2 L PEG + 20 mg bisacodyl, or PSMC + M was as efficacious as 4 L PEG and superior to NaP for bowel cleansing. A short interval between the completion of bowel preparation and the start of colonoscopy (ie, ‘runway time’), irrespective of bowel preparation regimen, appeared to be a more important predictor of bowel cleanliness than the cathartic agents used.