title: Ascorbic acid PEG-2L is superior for early morning colonoscopies in colorectal cancer screening programs: a prospective non-randomized controlled trial.
abstract: BACKGROUND
  The quality of colon cleansing and the tolerability of anterograde preparation are essential to the success of colorectal cancer screening.
  
  
  OBJECTIVE
  To compare the tolerability and efficacy of low-volume preparations vs the standard regimen in individuals scheduled for an early morning colonoscopy.
  
  
  METHODS
  Participants in a population-based colorectal cancer screening program using the fecal immunochemical test who were scheduled for a colonoscopy from 09:00 a.m. to 10:20 a.m. were prospectively included and assigned to: (1) control group (PEG-ELS 4L): PEG 4L and electrolytes; (2) group AscPEG-2L: a combination of PEG and ascorbic acid 2L; and (3) group PiMg: sodium picosulfate and magnesium citrate 500 mL plus 2L of clear fluids. Tolerability was evaluated with a questionnaire and the quality of bowel preparation with the Boston Bowel Preparation Scale.
  
  
  RESULTS
  A total of 292 participants were included: 98 in the PEG-ELS 4L control group, 96 in the AscPEG-2L study group and 98 in the PiMg study group. Low-volume treatments were better tolerated than the standard solution (AscPEG-2L 94.8% and PiMg 93.9% vs PEG-ELS 4L 75.5%; p < 0.0001). The effectiveness of AscPEG-2L was superior to that of PEG-ELS 4L and PiMg (p = 0.011 and p = 0.032, respectively). Patient acceptance was higher for single-dose than for split-dose administration but efficacy was higher with the split dose than with other doses.
  
  
  CONCLUSIONS
  In early morning colonoscopies, ascPEG-2L appears to be the best option, especially when administered in a split-dose.
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Rodríguez de Miguel
authors.affiliation: Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Serradesanferm
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: López-Cerón
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Carballal
authors.affiliation: Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Pozo
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Balaguer
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Cárdenas
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Fernández-Esparrach
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ginés
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: González-Suárez
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Moreira
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Ordás
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Ricart
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Sendino
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: E C
authors.initials: EC
authors.lastname: Vaquero
authors.affiliation: Department of Anesthesiology, Hospital Clínic, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Ubré
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: del Manzano
authors.affiliation: Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Grau
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Llach
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Castells
authors.affiliation: Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. Electronic address: mpellise@clinic.cat.
authors.forename: M
authors.initials: M
authors.lastname: Pellisé
mesh_terms: D000368:Aged; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D002400:Cathartics / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D002951:Citrates / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D019343:Citric Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003672:Defecation / Q000187:drug effects*; D004244:Dizziness / Q000139:chemically induced; D004334:Drug Administration Schedule; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D010146:Pain / Q000139:chemically induced; D010342:Patient Acceptance of Health Care; D010847:Picolines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000139:chemically induced
chemical_list: D002400:Cathartics; D002951:Citrates; D009942:Organometallic Compounds; D010847:Picolines; D019343:Citric Acid; D011092:Polyethylene Glycols; C005701:picosulfate sodium; D001205:Ascorbic Acid; C110422:magnesium citrate
keywords: Bowel cleansing; Clinical trial; Colonoscopia; Colonoscopia de calidad; Colonoscopy; Colorectal cancer screening; Cribado de cáncer colorectal; Ensayo clínico; Preparación anterógrada; Preparation; Quality endoscopy