A randomized prospective trial comparing different regimens of oral sodium phosphate and polyethylene glycol-based lavage solution in the preparation of patients for colonoscopy.
BACKGROUND
Regulatory agencies have warned clinicians regarding the risk of electrolyte abnormalities if more than two 45-mL bottles of oral sodium phosphate (NaP) solution are administered within a 24-hour period.


OBJECTIVE
To compare the efficacy, safety, and tolerability of different regimens of oral NaP and polyethylene glycol (PEG).


METHODS
Randomized controlled trial.


METHODS
Teaching hospital outpatient endoscopy clinic.


METHODS
Two hundred outpatients without comorbidities who underwent routine colonoscopy.


METHODS
Two bottles of NaP, 6, 12, or 24 hours apart; or 4 L PEG.


METHODS
Bowel preparation quality, patient tolerability, and electrolyte changes.


RESULTS
The 12- and 24-hour NaP achieved better cleansing than the 6-hour NaP or PEG. Only 8.5% and 8.3% of patients in the 24- and 12-hour NaP had poor preparations, respectively, compared with 15.6% and 23.4% in the 6-hour NaP and PEG, respectively. The poorer preparation scores with PEG were partly because of a greater amount of colonic fluid. There were no relevant electrolyte changes with PEG, whereas hypokalemia, hypocalcemia, or hyperphosphatemia developed in 5% to 57% of patients on NaP. All regimens were poorly tolerated by patients.


CONCLUSIONS
The study was likely underpowered to detect small group differences in electrolytes.


CONCLUSIONS
A 24- or 12-hour NaP bowel preparation strategy was more effective than NaP 6 hours apart or PEG. PEG use is associated with more residual colonic fluid but represents an alternative to NaP in some clinical situations.
Rostom
Alaa
A
Division of Gastroenterology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada.
Jolicoeur
Emilie
E
Dubé
Catherine
C
Grégoire
Sylvie
S
Patel
Dilip
D
Saloojee
Navaaz
N
Lowe
Catherine
C
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D003106:Colon; D003113:Colonoscopy; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017060:Patient Satisfaction; D010710:Phosphates / Q000008:administration & dosage* / Q000009:adverse effects; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D007507:Therapeutic Irrigation
D010710:Phosphates; D011092:Polyethylene Glycols; C018279:sodium phosphate