Elsevier

Gastrointestinal Endoscopy

Volume 40, Issue 4, July–August 1994, Pages 474-476
Gastrointestinal Endoscopy

Optimal bowel preparation for flexible sigmoidoscopy—Are two enemas better than one?,☆☆,,★★

This work was presented in part at the Present Concepts in Internal Medicine and 5th Army Regional Subspecialty Meetings sponsored by the American College of Physicians and the Office of the Surgeon General on October 20-23, 1988, in San Fancisco, California.
https://doi.org/10.1016/S0016-5107(94)70213-6Get rights and content

Abstract

Recommendations regarding optimal bowel preparation for fiberoptic flexible sigmoidoscopy remain anecdotal and inconclusive. We prospectively evaluated three commonly recommended regimens for administering hypertonic phosphate enemas to subjects undergoing 60-cm fiberoptic flexible sigmoidoscopy for routine indications. Patients were randomly assigned to one of three hypertonic phosphate enema regimens. Group A received one enema 1 hour before fiberoptic flexible sigmoidoscopy, group B received two enemas 1 hour before, and group C received one enema 3 hours before and a second enema 1 hour before fiberoptic flexible sigmoidoscopy. Adequacy of bowel preparation was graded as excellent, adequate, or poor. Results revealed no statistically significant difference in the adequacy of bowel preparation between the three regimens, all resulting in adequate or excellent preparation in approximately 80% of patients. We recommend the use of one hypertonic phosphate enema 1 hour before routine fiberoptic flexible sigmoidoscopy. Implementation of this recommendation is efficacious, convenient for patients, and cost-effective. (Gastrointest Endosc 1994;40:474-6.)

Section snippets

MATERIALS AND METHODS

One hundred patients undergoing flexible sigmoidoscopy for routine indications were randomized to one of three groups. Group A (35 patients) received one 4.5-oz hypertonic phosphate enema 1 hour before the procedure. Group B (34 patients) received two enemas 1 hour before the procedure. Group C (31 patients) received one enema 3 hours before and a second enema 1 hour before sigmoidoscopy. All patients were instructed to self-administer the enemas according to directions on the product box in

RESULTS

In group A, 82% of patients had excellent (40%) or adequate (42%) bowel preparation with the use of one enema 1 hour before flexible sigmoidoscopy. Identical results (41% excellent and 41% adequate) were noted in group B patients, who used two enemas 1 hour before the procedure. In group C, 71% of patients had an excellent (29%) or adequate (42%) preparation with the use of two enemas, one 3 hours and one 1 hour before sigmoidoscopy. Poor results were seen in 17% of group A and 18% of group B,

STATISTICAL ANALYSIS

For statistical purposes, the dependent variable—adequacy of preparation—was measured on a 3-point scale ranging from 3 (excellent) to 1 (poor). As seen in Figure 1, the mean and standard deviation for the three groups are similar.

. Graph shows numerical scores achieved with three different enema preparations.

By one-way analysis of variance, the results indicate no statistically significant difference between the three treatment regimens, with an F ratio of 1.03 and a p value of 0.36.

DISCUSSION

Flexible sigmoidoscopy is an integral part of the evaluation of the lower colon and rectum in patients with a wide range of gastrointestinal symptoms as well as in asymptomatic patients selected for colorectal screening programs. The effectiveness of the procedure depends on bowel preparation with cleansing enemas before the examination. Although many opinions are available in the literature as to the optimal number and timing of enemas for bowel preparation, no properly blinded and controlled

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Cited by (20)

  • Achieving quality in flexible sigmoidoscopy screening for colorectal cancer

    2001, American Journal of Medicine
    Citation Excerpt :

    Changing the diet before sigmoidoscopy is unnecessary (66). Most patients can be prepared with one or two enemas within 2 hours of the procedure (3,45,55,63,70–72). Cathartic enemas, such as phosphate enemas, are more effective than tap-water enemas, less traumatic than some laxatives (73), and widely available at pharmacies (55,63).

  • Prospective, randomized, single-blind comparison of two preparations for screening flexible sigmoidoscopy

    2000, Gastrointestinal Endoscopy
    Citation Excerpt :

    In the oral group a bowel preparation was rated as good or excellent in 86.5% of patients, as compared with only 57.3% in the enema group. The quality of the preparation in the enema group was considerably lower than that reported by Preston et al.28 (approximately 80%). This difference may be due to differences in the patient population studied, the grading scale used to rate the quality of the preparation, the timing of enema administration, or the use of bisacodyl in our patients.

  • Flexible sigmoidoscopy

    1997, Primary Care - Clinics in Office Practice
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From the Gastroenterology Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas.

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The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense or the U.S. Government.

Reprint requests: Kevin L. Preston, DO, Plaza Professional Center, 2918 Hamilton Boulevard, Sioux City, IA 51104.

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