title: MiraLAX vs. Golytely: is there a significant difference in the adenoma detection rate?
abstract: BACKGROUND
  In recent clinical trials (RCT) of bowel preparation, Golytely was more efficacious than MiraLAX. We hypothesised that there is a difference in adenoma detection between Golytely and MiraLAX.
  
  
  OBJECTIVE
  To compare the adenoma detection rate (ADR) between these bowel preparations, and to identify independent predictors of bowel preparation quality and adenoma detection.
  
  
  METHODS
  This was a post hoc analysis of an RCT that assessed efficacy and patient tolerability of Golytely vs. MiraLAX/Gatorade in average risk screening colonoscopy patients. Bowel preparation quality was measured with the Boston Bowel Preparation Scale (BBPS). An excellent/good equivalent BBPS score was defined as ≥ 7. Polyp pathology review was performed. ADR was defined as the proportion of colonoscopies with an adenoma. Univariate and multivariate analyses were conducted.
  
  
  RESULTS
  One hundred and ninety patients were prospectively enrolled (87 MiraLAX, 103 Golytely). Golytely had a higher rate of a BBPS score ≥ 7 (82.5% vs. MiraLAX 67.8%, P=0.02). The ADR in the Golytely cohort was 26.2% (27/103), and was 16.1% (14/87) for MiraLAX (P = 0.091). On multivariate analyses, Golytely was 2.13 × more likely to be associated with a BBPS ≥ 7 (95% CI 1.05-4.32, P = 0.04) and 2.28 × more likely to be associated with adenoma detection (95% CI 1.05-4.98, P = 0.04) than MiraLAX.
  
  
  CONCLUSIONS
  Golytely was more efficacious than MiraLAX in bowel cleansing, and was independently associated with both bowel prep quality (BBPS ≥ 7) and higher adenoma detection. Golytely should be used as first line for bowel prep for colonoscopy. Studies with larger populations are needed to confirm these results.
authors.affiliation: Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, OR, USA. brintha.enestvedt@uphs.upenn.edu
authors.forename: B K
authors.initials: BK
authors.lastname: Enestvedt
authors.forename: M
authors.initials: M
authors.lastname: Brian Fennerty
authors.forename: A
authors.initials: A
authors.lastname: Zaman
authors.forename: G M
authors.initials: GM
authors.lastname: Eisen
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000367:Age Factors; D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004573:Electrolytes; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D011092:Polyethylene Glycols; D011300:Preoperative Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012997:Solvents
chemical_list: D004573:Electrolytes; C033608:Golytely; D012997:Solvents; D011092:Polyethylene Glycols