Background
Picosulfate, magnesium oxide, and citric acid solution is a small-volume agent for
colon cleansing before colonoscopy that is extremely well tolerated by patients, safe,
and efficacious. Studies of other cleansing agents have suggested that split-dose
regimens may further enhance efficacy.
Objective
To examine whether split-dosing of picosulfate, magnesium oxide, and citric acid solution
increases bowel cleansing efficacy while maintaining tolerability and safety.
Design
Prospective, randomized, single-blinded, controlled trial.
Setting
Outpatient tertiary care center.
Patients
A total of 236 patients underwent colonoscopy (mean age 56 years, 53.8% female).
Interventions
Patients in the traditional arm (n = 123) consumed 1 sachet of solution at 5:00 pm and 10:00 pm the night before the colonoscopy. Patients in the split-dose arm (n = 127) consumed
1 sachet at 7:00 pm the night before and another sachet 4 hours before their colonoscopy appointment.
Main Outcome Measurements
Ottawa Bowel Preparation Scale (OBPS) score, Aronchick score, safety, tolerability.
Results
The 113 and 109 patients in the split-dose and traditional arms, respectively, had
OBPS scores for analysis. Overall, the OBPS scores in the split-dose group were significantly
improved compared with the traditional dose group (4.05 vs 5.51, P < .001). This was mostly attributed to improvements in right-sided colon cleansing
(1.22 in split-dose vs 2.14 in traditional arm, P < .001). Both regimens were well tolerated by patients, and no safety issues were
identified.
Limitations
This was a single-center study. Disturbances in sleep related to the preparation were
not assessed.
Conclusions
The split-dose regimen of picosulfate, magnesium oxide, and citric acid solution is
superior to the traditional dosing regimen for colon cleansing before colonoscopy.
(Clinical trial registration number: NCT00885274.)
Abbreviations:
OBPS (Ottawa Bowel Preparation Scale), PSLx (Pico-Salax)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Canadian Association of Gastroenterology position statement on screening individuals at average risk for developing colorectal cancer: 2010.Can J Gastroenterol. 2010; 24: 705-714
- Colon cleansing before colonoscopy: does oral sodium phosphate solution still make sense?.Can J Gastroenterol. 2009; 23: 210-214
- The impact of colon preparation timing on colonoscopic detection of colorectal neoplasms–a prospective endoscopist-blinded randomized trial.Am J Gastroenterol. 2006; 101: 2719-2725
- Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study.Gastrointest Endosc. 2005; 61: 378-384
- Maximizing detection of adenomas and cancers during colonoscopy.Am J Gastroenterol. 2006; 101: 2866-2877
- A prospective, controlled assessment of factors influencing acceptance of screening colonoscopy.Am J Gastroenterol. 2002; 97: 3186-3194
- The role of Picolax before whole gut irrigation in the preparation of the colon for large bowel surgery.Ann R Coll Surg Engl. 1988; 70: 322-323
- Sodium picosulfate/magnesium citrate: a review of its use as a colorectal cleanser.Drugs. 2009; 69: 123-136
- Pico-salax plus two-day bisacodyl is superior to pico-salax alone or oral sodium phosphate for colon cleansing before colonoscopy.Am J Gastroenterol. 2009; 104: 703-709
- 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.Gastrointest Endosc. 2005; 62: 213-218
- A randomized, controlled, double-blind trial of the adjunct use of tegaserod in whole-dose or split-dose polyethylene glycol electrolyte solution for colonoscopy preparation.Gastrointest Endosc. 2008; 68: 294-300
- Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy–timing is the key!.Dis Colon Rectum. 1998; 41: 1223-1225
- A randomized single-blind trial of whole versus split-dose polyethylene glycol-electrolyte solution for colonoscopy preparation.Gastrointest Endosc. 2003; 58: 36-40
- Cleansing ability and tolerance of three bowel preparations for colonoscopy.Dis Colon Rectum. 1997; 40: 100-104
- Comparison of two schedules (previous evening versus same morning) of bowel preparation for colonoscopy.Endoscopy. 2007; 39: 706-709
- Efficacy of morning-only compared with split-dose polyethylene glycol electrolyte solution for afternoon colonoscopy: a randomized controlled single-blind study.Am J Gastroenterol. 2010; 105: 1954-1961
- Quality and effect of single dose versus split dose of polyethylene glycol bowel preparation for early-morning colonoscopy.Endoscopy. 2007; 39: 616-619
- 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: 1319-1326
- The timing of bowel preparation before colonoscopy determines the quality of cleansing, and is a significant factor contributing to the detection of flat lesions: a randomized study.World J Gastroenterol. 2006; 12: 6161-6166
- A randomized prospective trial comparing different regimens of oral sodium phosphate and polyethylene glycol-based lavage solution in the preparation of patients for colonoscopy.Gastrointest Endosc. 2006; 64: 544-552
- Validation of a new scale for the assessment of bowel preparation quality.Gastrointest Endosc. 2004; 59: 482-486
- Validation of an instrument to assess colon cleansing [abstract].Am J Gastroenterol. 1999; 94: 2667
- A multicentre, observational study of sodium picosulfate and magnesium citrate as a precolonoscopy bowel preparation.Can J Gastroenterol. 2009; 23: 706-710
- Efficacy and tolerability of split-dose PEG compared with split-dose aqueous sodium phosphate for outpatient colonoscopy: a randomized, controlled trial.Dig Dis Sci. 2011; 56: 2963-2971
- Efficacy of prepackaged, low residual test meals with 4L polyethylene glycol versus a clear liquid diet with 4L polyethylene glycol bowel preparation: s randomized trial.J Gastroenterol Hepatol. 2009; 24: 988-991
- Association of colonoscopy and death from colorectal cancer.Ann Intern Med. 2009; 150: 1-8
- Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy.Clin Gastroenterol Hepatol. 2011; 9: 42-46
- Willingness to undergo split-dose bowel preparation for colonoscopy and compliance with split-dose instructions.Dig Dis Sci. 2010; 55: 2030-2034
Article info
Publication history
Published online: December 23, 2011
Accepted:
September 6,
2011
Received:
July 13,
2011
Footnotes
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Drs. Hookey and Vanner are consultants to and educational grant recipients from Ferring Canada and Ferring USA. The other author disclosed no financial relationship relevant to this publication.
Identification
Copyright
© 2012 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
