Although the idea of having an endoscope inserted into the rectum may be a strong deterrent for many from obtaining a colonoscopy, patients who have undergone the procedure frequently tell me that the bowel preparation is the worst part of the process. Besides having to tolerate the distasteful bowel preparation cocktail, there are the hours of explosive watery diarrhea to endure.
Researchers at the Sungkyunkwan University School of Medicine (Seoul, Korea) recently evaluated the efficacy and tolerability of three bowel preparation regimens for morning colonoscopy. A total of 232 patients were randomized to one of three groups based on their bowel preparation regimen: Group 1 received 4 L of PEG (polyethylene glycol); Group 2 received split-doses of PEG (2 L on the day prior to colonoscopy and 2 L on the day of the procedure); and, Group 3 received split-doses of magnesium citrate (250 mL on the day prior to colonoscopy) and PEG (2 L on the day of the procedure).
Group 3 (bowel preparation with split-dose magnesium citrate-PEG) experienced equivalent or increased rates of adequate bowel preparation compared to the split-dose (75% vs. 76%, p=0.896) or full-dose (75% vs. 51%, p=0.001) PEG recipients, respectively. The rates of patient satisfaction showed similar trends in Group 3 being equivalent to Group 2 (43% vs. 35%, p=0.133) and superior to Group 1 (43% vs. 23%, p=0.010). Patients who received the split-dose magnesium citrate-PEG regimen were more willing to repeat the same bowel preparation regimen than those who only received PEG (p<0.001).
Poor bowel preparation is an inconvenience for everyone. The patient would have to repeat the preparation and reschedule the procedure for another day. The endoscopy center would have a pre-scheduled slot that may go unfilled leading to decreased productivity. And in cases where the poor bowel preparation is discovered after administration of sedation and insertion of the endoscope, the expenditure of resources is even greater. The concept of a more efficient and better tolerated bowel preparation regimen is therefore very helpful. I will try the new regimen on my patients and see whether this will lead to a temporary or longer-term change of practice.
- Source
- Park SS, Sinn DH, Kim YH, Lim YJ, Sun Y, Lee JH, Kim JY, Chang DK, Son HJ, Rhee PL, Rhee JC, Kim JJ. Efficacy and tolerability of split-dose magnesium citrate: low-volume (2 liters) polyethylene glycol vs. single- or split-dose polyethylene glycol bowel preparation for morning colonoscopy. Am J Gastroenterol 2010;105:1319-26.