title: Efficacy of morning-only 4 liter sulfa free polyethylene glycol vs 2 liter polyethylene glycol with ascorbic acid for afternoon colonoscopy.
abstract: OBJECTIVE
  To compare the bowel cleansing efficacy of same day ingestion of 4-L sulfa-free polyethylene glycol (4-L SF-PEG) vs 2-L polyethylene glycol solution with ascorbic acid (2-L PEG + Asc) in patients undergoing afternoon colonoscopy.
  
  
  METHODS
  206 patients (mean age 56.7 years, 61% male) undergoing outpatient screening or surveillance colonoscopies were prospectively randomized to receive either 4-L SF-PEG (n = 104) or 2-L PEG + Asc solution (n = 102). Colonoscopies were performed by two blinded endoscopists. Bowel preparation was graded using the Ottawa scale. Each participant completed a satisfaction and side effect survey.
  
  
  RESULTS
  There was no difference in patient demographics amongst groups. 4-L SF-PEG resulted in better Ottawa scores compared to 2-L PEG + Asc, 4.2 vs 4.9 (P = 0.0186); left colon: 1.33 vs 1.57 respectively (P = 0.0224), right colon: 1.38 vs 1.63 respectively (P = 0.0097). No difference in Ottawa scores was found for the mid colon or amount of fluid. Patient satisfaction was similar for both arms but those assigned to 4-L SF-PEG reported less bloating: 23.1% vs 11.5% (P = 0.0235). Overall polyp detection, adenomatous polyp and advanced adenoma detection rates were similar between the two groups.
  
  
  CONCLUSIONS
  Morning only 4-L SF-PEG provided superior cleansing with less bloating as compared to 2-L PEG + Asc bowel preparation for afternoon colonoscopy. Thus, future studies evaluating efficacy of morning only preparation for afternoon colonoscopy should use 4-L SF-PEG as the standard comparator.
authors.affiliation: John M Rivas, Alison Schneider, Fernando J Castro, Digestive Disease Center, Cleveland Clinic Florida, Weston, FL 33331, United States.
authors.forename: John M
authors.initials: JM
authors.lastname: Rivas
authors.affiliation: John M Rivas, Alison Schneider, Fernando J Castro, Digestive Disease Center, Cleveland Clinic Florida, Weston, FL 33331, United States.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Perez
authors.affiliation: John M Rivas, Alison Schneider, Fernando J Castro, Digestive Disease Center, Cleveland Clinic Florida, Weston, FL 33331, United States.
authors.forename: Marlow
authors.initials: M
authors.lastname: Hernandez
authors.affiliation: John M Rivas, Alison Schneider, Fernando J Castro, Digestive Disease Center, Cleveland Clinic Florida, Weston, FL 33331, United States.
authors.forename: Alison
authors.initials: A
authors.lastname: Schneider
authors.affiliation: John M Rivas, Alison Schneider, Fernando J Castro, Digestive Disease Center, Cleveland Clinic Florida, Weston, FL 33331, United States.
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Castro
mesh_terms: D000236:Adenoma / Q000473:pathology*; D001205:Ascorbic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D002400:Cathartics / Q000008:administration & dosage* / Q000009:adverse effects; D003110:Colonic Neoplasms / Q000473:pathology*; D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy; D004334:Drug Administration Schedule; D005260:Female; D005431:Florida; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors
chemical_list: D002400:Cathartics; D011092:Polyethylene Glycols; D001205:Ascorbic Acid
keywords: Bowel preparation; Colon cancer screening; Colonoscopy; Screening colonoscopy