title: Randomized trial of low-volume PEG solution versus standard PEG + electrolytes for bowel cleansing before colonoscopy.
abstract: OBJECTIVE
  Polyethylene glycol (PEG)-based gut lavage solutions are safe and effective, but require consumption of large volumes of fluid. We compared a new 2 L solution of PEG plus ascorbic acid (PEG + Asc) with standard 4 L PEG with electrolytes (PEG + E) for bowel cleansing before colonoscopy to determine efficacy, safety, and patient acceptability.
  
  
  METHODS
  Consenting adult inpatients scheduled to undergo colonoscopy were randomized to receive either 2 L PEG + Asc or 4 L PEG + E. Preparations were taken as split doses the evening before colonoscopy and the following morning. The PEG + Asc group took 1 L at each administration (i.e., total dose of 2 L). The PEG + E group took 2 L at each administration (i.e., total dose of 4 L). Bowel cleansing success was assessed via videotapes by independent, blinded raters. Statistical noninferiority was predefined as a difference of <15% in the lower limit of the 97.5% confidence interval for treatment difference. Patient views on the preparations were elicited. Adverse events were noted.
  
  
  RESULTS
  Successful gut cleansing was achieved in 136 of 153 (88.9%) cases of the PEG + Asc group and 147 of 155 (94.8%) cases of the 4 L PEG + E group (mean difference -5.9 [-12.0-infinity]). The difference fell within the predefined limit for noninferiority. Clinical and laboratory parameters showed no difference in safety profile. Patient ratings of acceptability and taste were better for the PEG + Asc group than for the PEG + E group (P < 0.025).
  
  
  CONCLUSIONS
  The combination of ascorbic acid and PEG-based bowel preparation reduces the volume patients have to drink without compromising efficacy or safety. The low-volume PEG + Asc preparation was more acceptable to patients, and should, therefore, improve effectiveness in routine practice.
authors.affiliation: Dr. Horst Schmidt Kliniken GmbH, Wiesbaden, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ell
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Fischbach
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Bronisch
authors.forename: Stefan
authors.initials: S
authors.lastname: Dertinger
authors.forename: Peter
authors.initials: P
authors.lastname: Layer
authors.forename: Michael
authors.initials: M
authors.lastname: Rünzi
authors.forename: Thomas
authors.initials: T
authors.lastname: Schneider
authors.forename: Günther
authors.initials: G
authors.lastname: Kachel
authors.forename: Jörg
authors.initials: J
authors.lastname: Grüger
authors.forename: Michael
authors.initials: M
authors.lastname: Köllinger
authors.forename: Waltraud
authors.initials: W
authors.lastname: Nagell
authors.forename: Karl-Josel
authors.initials: KJ
authors.lastname: Goerg
authors.forename: Roland
authors.initials: R
authors.lastname: Wanitschke
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Gruss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001205:Ascorbic Acid / Q000008:administration & dosage*; D002400:Cathartics / Q000008:administration & dosage*; D003113:Colonoscopy; D004573:Electrolytes / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D012996:Solutions; D007507:Therapeutic Irrigation
chemical_list: D002400:Cathartics; D004573:Electrolytes; D012996:Solutions; D011092:Polyethylene Glycols; D001205:Ascorbic Acid