Original Article
A randomized single-blind trial of split-dose PEG-electrolyte solution without dietary restriction compared with whole dose PEG-electrolyte solution with dietary restriction for colonoscopy preparation

https://doi.org/10.1016/S0016-5107(05)00371-8Get rights and content

Background

Colonoscopy preparation regimens are poorly tolerated, requiring the use of a large volume of an unpalatable solution and diet restriction for adequate cleansing. The aim of this study was to compare the efficacy of two regimens of bowel preparation before colonoscopy: a whole dose of polyethylene glycol electrolyte solution (PEG-E), with diet restriction vs. a split dose with no diet restriction.

Methods

A total of 141 patients (ages 20-84 years, 81 men) were randomly assigned to receive either 4 L PEG-E, along with a liquid diet the day before colonoscopy (Group A) or 2 L PEG-E with a regular diet the day before colonoscopy followed by another 2 L PEG-E on the day of the procedure (Group B). The quality of the preparation was graded by the endoscopist (poor to excellent), who was blinded to the type of preparation. Tolerability of the assigned preparation and adverse effects were recorded by an independent investigator by using a questionnaire administered before colonoscopy. Intra- and interobserver variability was studied by using randomly chosen videotapes of colonoscopies performed as part of the study.

Results

There were 73 patients in Group A and 68 patients in Group B. The quality of the preparation was significantly better in Group B (p = 0.011). The tolerability of the preparation regimen was not different overall between study groups in terms of side effects (except for bloating, which was more frequent in Group B, p = 0.039) or willingness to repeat the preparation. There was a nonsignificant trend toward improved adherence to the assigned preparation in favor of Group B (p = 0.062). Inter- and intraobserver variability analysis showed good to excellent correlation among endoscopists.

Conclusions

Colonic preparation with split-dose PEG-E and no dietary restriction provides better quality colon cleansing than whole-dose preparation, with no significant impact on patient tolerability and side effects.

Section snippets

Patients

Patients seen in the ambulatory outpatient clinic of the American University of Beirut Medical Center who required elective colonoscopies were enrolled in this study. Exclusion criteria included patients under 18 years of age, the presence of a severe illness (cardiac, renal, or metabolic), active alcoholism, drug addiction, major psychiatric illness, known allergies to PEG, or refusal to consent to the study. The study was conducted at the American University of Beirut Medical Center between

Results

A total of 141 patients were approached, recruited, and randomized into Group A (73 patients) or Group B (68 patients). None of the patients declined, dropped out, or were excluded for any reason. Recruitment did not involve consecutive patients because of scheduling purposes (study patients had to be scheduled as of 9:00 AM). There were 80 men and 61 women, with a mean age of 57 ± 14 years (range 20-84 years). Patient demographics and indications for colonoscopy are listed in Table 2.

The

Discussion

Colonoscopy remains the most preferred procedure for diagnosing colonic and terminal ileal disease. A successful procedure requires an adequate bowel preparation. The currently used bowel-cleansing solutions dictate the rapid ingestion of large amounts of unpalatable fluids, as well as adherence to a liquid diet. These regimens overburden patients and justify the commonly used statement that “the preparation is worse than the procedure.” Many studies have tackled these concerns by trying to

References (20)

There are more references available in the full text version of this article.

Cited by (202)

  • Preparation for colonoscopy: Recommendations by an expert panel in Italy

    2018, Digestive and Liver Disease
    Citation Excerpt :

    There are few certainties as to the diet to be adopted before colonoscopy [31–35]. Two very recent meta-analyses showed that a low-fibre diet provides a preparation quality that is non-inferior to a clear liquid diet and is associated with better tolerability and compliance [35–40]. There is no clear evidence in the literature that prolonging dietary restrictions for more than one day before colonoscopy improves the quality of bowel preparation.

  • Gastrointestinal endoscopy in patients of advanced age

    2018, Revista Espanola de Geriatria y Gerontologia
  • Primary Data Collection

    2023, Clinical Analytics and Data Management for the DNP, Third Edition
View all citing articles on Scopus

See CME section; p. 275.

View full text