Optimal bowel preparation for flexible sigmoidoscopy—Are two enemas better than one?☆,☆☆,★,★★
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. 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 MedicineCitation 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 EndoscopyCitation 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.
A randomized trial comparing three methods of Bowel preparation for flexible sigmoidoscopy
1998, American Journal of GastroenterologyFlexible 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.
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Reprint requests: Kevin L. Preston, DO, Plaza Professional Center, 2918 Hamilton Boulevard, Sioux City, IA 51104.
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