title: 'Pico-Bello-Klean study': effectiveness and patient tolerability of bowel preparation agents sodium picosulphate-magnesium citrate and polyethylene glycol before colonoscopy. A single-blinded randomized trial.
abstract: OBJECTIVE
  Adequate bowel preparation is an important step for an effective colonoscopy. Polyethylene glycol solution (Kleanprep) and sodium picosulphate with a magnesium citrate solution (Picoprep) are bowel cleansing agents registered and available for this purpose. So far, the results of studies comparing the effectiveness of bowel cleansing between the two agents are inconclusive. This may be because of differences in administration regimes and subjective measurement of bowel cleansing.In this single-blinded randomized-controlled trial, the effectiveness of Kleanprep and Picoprep was examined using a split-dose regimen and an objective bowel cleansing score system.
  
  
  METHODS
  One hundred and seventy-three consecutive patients referred for outpatient colonoscopy were included, the required number based on power analysis. Eighty-eight patients received Kleanprep; 85 received Picoprep. The primary outcome was the effectiveness of bowel cleansing using the Boston Bowel Preparation Score. The secondary outcome was patient tolerability measured using a questionnaire. An intention-to-treat-analysis was carried out.
  
  
  RESULTS
  The overall Boston Bowel Preparation Score between Kleanprep and Picoprep was not significantly different (P=0.182). On reviewing segment scores, there were also no significant differences between Kleanprep and Picoprep. Patients using Picoprep scored significantly better on the aspects of convenience and flavour of the preparation agent compared with patients using Kleanprep (P<0.001). Side effects such as nausea (P=0.011), vomiting (P=0.001), headache (P=0.003) and bloating (P<0.001) were experienced less significantly by patients using Picoprep.
  
  
  CONCLUSIONS
  The present study did not find a difference in the effectiveness of bowel cleansing between Kleanprep and Picoprep. Both were found to be adequate cleansing agents. Picoprep was significantly better tolerated than Kleanprep. Therefore, we recommend Picoprep as a first-choice regimen for bowel preparation before colonoscopy.
authors.affiliation: aDepartment of Gastroenterology and Hepatology bResearch Centre Linnaeus Institute, Kennemer Gasthuis, Haarlem, The Netherlands.
authors.forename: Isabelle D
authors.initials: ID
authors.lastname: Munsterman
authors.forename: Eva
authors.initials: E
authors.lastname: Cleeren
authors.forename: Tjeerd
authors.initials: T
authors.lastname: van der Ploeg
authors.forename: Richard
authors.initials: R
authors.lastname: Brohet
authors.forename: René
authors.initials: R
authors.lastname: van der Hulst
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* / Q000592:standards; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D057240:Patient Preference; D010847:Picolines / Q000008:administration & dosage* / Q000009:adverse effects; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013649:Taste
chemical_list: D002400:Cathartics; D002951:Citrates; D009942:Organometallic Compounds; D010847:Picolines; D019343:Citric Acid; D011092:Polyethylene Glycols; C005701:picosulfate sodium; C110422:magnesium citrate