Pico-salax plus two-day bisacodyl is superior to pico-salax alone or oral sodium phosphate for colon cleansing before colonoscopy.
OBJECTIVE
This study examined whether Pico-Salax alone or Pico-Salax plus bisacodyl tablets for two nights before colonoscopy afford superior efficacy, patient tolerance, and safety compared with oral sodium phosphate.


METHODS
Patients undergoing outpatient colonoscopy were randomized to receive either Pico-Salax at 5 and 10 PM the night before colonoscopy plus bisacodyl 10 mg at 5 PM in the two earlier evenings (n=105), Pico-Salax alone at 5 and 10 PM the night before colonoscopy (n=109), or oral sodium phosphate at 5 and 10 PM the night (n=101) before colonoscopy. All groups were encouraged to drink 3-4 l of Gatorade or other clear fluids the night before the colonoscopy.


RESULTS
Global scoring of cleansing efficacy using the Ottawa scale did not reveal differences among groups, but Pico-Salax plus bisacodyl was superior in cleansing the right colon compared with the other regimens (P=0.003), providing almost 50% improvement over oral sodium phosphate. Patient tolerance of Pico-Salax plus bisacodyl did not differ from Pico-Salax alone but was much better than oral sodium phosphate (P<0.0001). Hemodynamic and biochemical monitoring of patients on Pico-Salax plus bisacodyl suggests this regimen has a very strong safety profile. It does not differ from Pico-Salax alone, which lacks the hyperphosphatemia and hypocalcemia associated with oral sodium phosphate.


CONCLUSIONS
Together, these data suggest that Pico-Salax plus bisacodyl provides enhanced colon cleansing in the right colon compared with Pico-Salax alone or oral sodium phosphate, but this finding does not compromise the much greater tolerability or the safety profile of Pico-Salax alone.
Hookey
Lawrence C
LC
Department of Medicine, Queen's University, Kingston, Ontario, Canada. lawrencehookey@yahoo.ca
Vanner
Stephen J
SJ
D000284:Administration, Oral; D001726:Bisacodyl / Q000008:administration & dosage* / Q000009:adverse effects; D002400:Cathartics; D002951:Citrates; D019343:Citric Acid / Q000008:administration & dosage* / Q000009:adverse effects; D003113:Colonoscopy; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008277:Magnesium Oxide / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D017060:Patient Satisfaction; D010710:Phosphates / Q000008:administration & dosage* / Q000009:adverse effects; D010847:Picolines / Q000008:administration & dosage* / Q000009:adverse effects; D016037:Single-Blind Method
D002400:Cathartics; D002951:Citrates; D009942:Organometallic Compounds; D010710:Phosphates; C574900:Pico-Salax; D010847:Picolines; D001726:Bisacodyl; D019343:Citric Acid; D008277:Magnesium Oxide; C005701:picosulfate sodium; C018279:sodium phosphate