title: Same-day 2-L PEG-citrate-simethicone plus bisacodyl vs split 4-L PEG: Bowel cleansing for late-morning colonoscopy.
abstract: OBJECTIVE
  To evaluate the efficacy, tolerability, acceptability and feasibility of bisacodyl plus low volume polyethyleneglycol-citrate-simeticone (2-L PEG-CS) taken the same day as compared with conventional split-dose 4-L PEG for late morning colonoscopy.
  
  
  METHODS
  Randomised, observer-blind, parallel group, comparative trial carried out in 2 centres. Out patients of both sexes, aged between 18 and 85 years, undergoing colonoscopy for diagnostic investigation, colorectal cancer screening or follow-up were eligible. The PEG-CS group received 3 bisacodyl tablets (4 tablets for patients with constipation) at bedtime and 2-L PEG-CS in the morning starting 5 h before colonoscopy. The control group received a conventional 4-L PEG formulation given as split regimen; the morning dose was taken with the same schedule of the low volume preparation. The Ottawa Bowel Preparation Scale (OBPS) score was used as the main outcome measure.
  
  
  RESULTS
  A total of 164 subjects were enrolled and 154 completed the study; 78 in the PEG-CS group and 76 in the split 4-L PEG group. The two groups were comparable at baseline. The OBPS score in the PEG-CS group (3.09 ± 2.40) and in the PEG group (2.39 ± 2.55) were equivalent (difference +0.70; 95%CI: -0.09-1.48). This was confirmed by the rate of successful bowel cleansing in the PEG-CS group (89.7%) and in the PEG group (92.1%) (difference -2.4%; 95%CI: -11.40- 6.70). PEG-CS was superior in terms of mucosa visibility compared to PEG (85.7% vs 72.4%, P = 0.042). There were no significant differences in caecum intubation rate, time to reach the caecum and withdrawal time between the two groups. The adenoma detection rate was similar (PEG-CS 43.6% vs PEG 44.7%). No serious adverse events occurred. No difference was found in tolerability of the bowel preparations. Compliance was equal in both groups: more than 90% of subjects drunk the whole solution. Willingness to repeat the same bowel preparations was about 90% for both regimes.
  
  
  CONCLUSIONS
  Same-day PEG-CS is feasible, effective as split-dose 4-L PEG for late morning colonoscopy and does not interfere with work and daily activities the day before colonoscopy.
authors.affiliation: Annalisa de Leone, Darina Tamayo, Giancarla Fiori, Davide Ravizza, Cristina Trovato, Giuseppe De Roberto, Cristiano Crosta, Division of Endoscopy, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: de Leone
authors.forename: Darina
authors.initials: D
authors.lastname: Tamayo
authors.forename: Giancarla
authors.initials: G
authors.lastname: Fiori
authors.forename: Davide
authors.initials: D
authors.lastname: Ravizza
authors.forename: Cristina
authors.initials: C
authors.lastname: Trovato
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Roberto
authors.forename: Linda
authors.initials: L
authors.lastname: Fazzini
authors.forename: Marco
authors.initials: M
authors.lastname: Dal Fante
authors.forename: Cristiano
authors.initials: C
authors.lastname: Crosta
keywords: Bowel preparation; Colonoscopy; Ottawa Bowel Preparation Scale; Polyethyleneglycol; Simethicone
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