title: Split-dose picosulfate, magnesium oxide, and citric acid solution markedly enhances colon cleansing before colonoscopy: a randomized, controlled trial.
abstract: BACKGROUND
  Picosulfate, magnesium oxide, and citric acid solution is a small-volume agent for colon cleansing before colonoscopy that is extremely well tolerated by patients, safe, and efficacious. Studies of other cleansing agents have suggested that split-dose regimens may further enhance efficacy.
  
  
  OBJECTIVE
  To examine whether split-dosing of picosulfate, magnesium oxide, and citric acid solution increases bowel cleansing efficacy while maintaining tolerability and safety.
  
  
  METHODS
  Prospective, randomized, single-blinded, controlled trial.
  
  
  METHODS
  Outpatient tertiary care center.
  
  
  METHODS
  A total of 236 patients underwent colonoscopy (mean age 56 years, 53.8% female).
  
  
  METHODS
  Patients in the traditional arm (n = 123) consumed 1 sachet of solution at 5:00 pm and 10:00 pm the night before the colonoscopy. Patients in the split-dose arm (n = 127) consumed 1 sachet at 7:00 pm the night before and another sachet 4 hours before their colonoscopy appointment.
  
  
  METHODS
  Ottawa Bowel Preparation Scale (OBPS) score, Aronchick score, safety, tolerability.
  
  
  RESULTS
  The 113 and 109 patients in the split-dose and traditional arms, respectively, had OBPS scores for analysis. Overall, the OBPS scores in the split-dose group were significantly improved compared with the traditional dose group (4.05 vs 5.51, P < .001). This was mostly attributed to improvements in right-sided colon cleansing (1.22 in split-dose vs 2.14 in traditional arm, P < .001). Both regimens were well tolerated by patients, and no safety issues were identified.
  
  
  CONCLUSIONS
  This was a single-center study. Disturbances in sleep related to the preparation were not assessed.
  
  
  CONCLUSIONS
  The split-dose regimen of picosulfate, magnesium oxide, and citric acid solution is superior to the traditional dosing regimen for colon cleansing before colonoscopy. (
  
  
  BACKGROUND
  NCT00885274.).
authors.affiliation: Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Flemming
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Vanner
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Hookey
mesh_terms: D002400:Cathartics / Q000008:administration & dosage*; D002951:Citrates; D019343:Citric Acid / Q000008:administration & dosage*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008277:Magnesium Oxide / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D010847:Picolines / Q000008:administration & dosage*; D011300:Preoperative Care; D011446:Prospective Studies; D016037:Single-Blind Method; D012996:Solutions; D007507:Therapeutic Irrigation / Q000592:standards
chemical_list: D002400:Cathartics; D002951:Citrates; D009942:Organometallic Compounds; D010847:Picolines; D012996:Solutions; D019343:Citric Acid; D008277:Magnesium Oxide; C005701:picosulfate sodium