title: A single or split dose picosulphate/magnesium citrate before colonoscopy: comparison regarding tolerance and efficacy with polyethylene glycol. A randomized trial.
abstract: OBJECTIVE
  To compare the efficacy and tolerance of sodium picosulphate/magnesium citrate (PMC) and polyethylene glycol (PEG) in a single or split dose regimen for colonoscopy bowel preparation.
  
  
  METHODS
  A prospective, randomized, endoscopist-blinded, multicenter study. The patients were randomly assigned to receive PMC (PMC4/0) or PEG (PEG4/0) in a single dose 4L day before colonoscopy or a split dose 2+2L PMC (PMC2/2) or 3+1L PEG (PEG3/1) one day before and in the morning before the colonoscopy. Each patient was interviewed to determine his/her subjective tolerance of the preparation before the procedure. The quality of bowel cleansing was assessed in a blinded test performed by multiple endoscopists using the Aronchick scale.
  
  
  RESULTS
  A total of 600 patients were enrolled, 88.2% were included in the analysis. Satisfactory bowel cleansing (Aronchick score 1 and 2) was significantly more frequent when a split dose was used irrespective of the solution type (81.6% PMC2/2, 87.3% PEG3/1 vs. 73.0% PEG4/0, p = 0.024). In single dose regimens, PMC performed better than PEG (82.6% vs. 73.0%). Single or split dose PMC preparations were comparable. A PMC based solution was generally better tolerated than PEG regardless of the regimen used (p < 0.001). Nausea was reported mostly after the 4L PEG (32.8%, p < 0.001), incontinence after a split PMC dose (34.4%, p = 0.002), and bloating after the 4L PEG (38.0%, p < 0.001). There was no significant difference in the prevalence of vomiting.
  
  
  CONCLUSIONS
  Colonic preparation with PMC yields similar results as a split PEG dose, regardless of whether PMC is administered in single or separate doses. PMC is better tolerated than any PEG-based preparation. A single 4L PEG the day before the colonoscopy is less appropriate for bowel cleansing.
authors.affiliation: Internal Clinic IPVZ, Bata Regional Hospital, Zlin, Czech Republic. kojecky@bnzlin.cz.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kojecky
authors.affiliation: Dept. of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Dolina
authors.affiliation: 2nd Clinic of Internal Medicine, Department of Gastroenterology, St´. Anne´s University Hospital, Brno,Czech Republic.
authors.forename: Bohuslav
authors.initials: B
authors.lastname: Kianicka
authors.affiliation: Internal Clinic IPVZ, Bata Regional Hospital, Zlin, Czech Republic.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Misurec
authors.affiliation: Internal Clinic IPVZ, Bata Regional Hospital, Zlin, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Varga
authors.affiliation: Internal Clinic IPVZ, Bata Regional Hospital, Zlin, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Latta
authors.affiliation: Hospital Vsetin Czech Republic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Vaculin
mesh_terms: D000328:Adult; D000368:Aged; D002400:Cathartics / Q000008:administration & dosage* / Q000009:adverse effects; D002951:Citrates / Q000008:administration & dosage* / Q000009:adverse effects; D019343:Citric Acid / Q000008:administration & dosage* / Q000009:adverse effects; D003113:Colonoscopy / Q000379:methods*; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D010349:Patient Compliance; D010847:Picolines / Q000008:administration & dosage* / Q000009:adverse effects; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D002400:Cathartics; D002951:Citrates; D004338:Drug Combinations; D009942:Organometallic Compounds; D010847:Picolines; D019343:Citric Acid; D011092:Polyethylene Glycols; C005701:picosulfate sodium; C110422:magnesium citrate