title: Single-day sodium picosulfate and magnesium citrate versus split-dose polyethylene glycol for bowel cleansing prior to colonoscopy: A prospective randomized endoscopist-blinded trial.
abstract: OBJECTIVE
  The intake of polyethylene glycol (PEG) prior colonoscopy is frequently associated with nausea and abdominal discomfort. The aim of this study was to investigate whether sodium picosulfate and magnesium citrate (PMC) is superior to a polyethylene glycol (PEG) preparation in regard to patient acceptance. Furthermore, it investigates possible differences in efficiency and patient safety.
  
  
  METHODS
  In a randomised, prospective, and endoscopist-blinded study patients were 1:1 randomized to either use PMC or 4-L PEG in order to prepare for colonoscopy. Cleansing regimes consisted of a split-dose administration in the PEG arm and standard administration in the PMC arm. Primary end point was proportion of patients evaluating the bowel preparation procedure as "very distressing," defined as ≥ 8 points on a 10-point numeric rating scale (NRS). Secondary end points were quality of bowel preparation and electrolyte parameters.
  
  
  RESULTS
  PMC bowel-cleansing procedure was better tolerated compared with PEG (PMC(NRS<8)  = 89.9% vs PEG(NRS<8)  = 79.2%, P = 0.037). Mean declines in serum sodium (ΔSodium(PEG)  = -0.76 ± 3.07 vs ΔSodium(PMC)  = -3.38 ± 3.56 mmol/L; P < 0.001), chloride (ΔChloride(PEG)  = -1.00 ± 3.22 vs ΔChloride(PMC)  = -3.49 ± 3.51 mmol/L; P < 0.001), and osmolality (ΔOsmolality(PEG)  = -4.23 ± 6.82 vs ΔOsmolality(PMC)  = -8.83 ± 7.43 mosmol/kg; P < 0.001) were higher in the PMC arm than in the PEG arm. Hyponatremia after bowel preparation occurred more often in PMC (21.2%) than in PEG (4.0%) (P < 0.001). Successful preparation was achieved more frequently in the PEG arm (42.9% vs 82.2%; P < 0.001).
  
  
  CONCLUSIONS
  Standard picosulfate/magnesium citrate is better accepted than a split-dose PEG regimen. From the perspective of successful preparation and patients' safety, PEG is superior to PMC.
authors.affiliation: 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Klare
authors.affiliation: 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Poloschek
authors.affiliation: 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Walter
authors.affiliation: Department of Medical Statistics and Epidemiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Ina-Christine
authors.initials: IC
authors.lastname: Rondak
authors.affiliation: 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Soher
authors.initials: S
authors.lastname: Attal
authors.affiliation: 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Weber
authors.affiliation: 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: von Delius
authors.affiliation: 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Monther
authors.initials: M
authors.lastname: Bajbouj
authors.affiliation: 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.affiliation: 2nd Medical Department, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huber
mesh_terms: D000328:Adult; D000368:Aged; D002400:Cathartics / Q000008:administration & dosage*; D002951:Citrates / Q000008:administration & dosage*; D019343:Citric Acid / Q000008:administration & dosage*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage*; D061214:Patient Safety; D010847:Picolines / Q000008:administration & dosage*; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011446:Prospective Studies
chemical_list: D002400:Cathartics; D002951:Citrates; D009942:Organometallic Compounds; D010847:Picolines; D019343:Citric Acid; D011092:Polyethylene Glycols; C005701:picosulfate sodium; C110422:magnesium citrate
keywords: colonoscopy; nausea; picosulfate; preparation; side effect