Background and aim: The addition of a laxative prior to a standard bowel preparation (BP) has shown variable results in efficacy, safety, and tolerability of the BP. This study compared the efficacy and tolerability of a macrogol-augmented BP (M-BP) with standard BP for routine colonoscopy in unselected patients.
Methods: Adults undergoing outpatient colonoscopy were randomized to either M-BP (one sachet of macrogol-based osmotic laxative (MBOL) twice daily for eight doses prior to standard preparation) or BP (split-dose of polyethylene glycol and sodium picosulfate). Bowel cleansing was assessed using the Ottawa BP scale. Risk factors for poor BP, patient satisfaction, and tolerance were recorded.
Results: This randomized trial was stopped due to futility after 14 months; at that point, 92 subjects were randomized to the study arm and 102 to the control arm. M-BP had a success rate of 71.7% (95% CI: 58.5-82.7%), while the BP had a success rate of 67.7% (95% CI: 54.9-78.8%), with a Pearson χ 2 test P-value of 0.639, which exceeded the cut-off for futility (0.313). In subgroup analyses, there were statistically significant decreases in the rates of successful BP in patients taking regular opioids and regular laxatives. Both preparations were well tolerated, with no difference between groups (BP - 5.3% and M-BP - 6.6% P = 0.66).
Conclusion: The addition of MBOL prior to a standard BP in unselected subjects does not significantly improve bowel cleanliness at routine colonoscopy. The role of this laxative in patients at high risk of poor preparation warrants further investigation.
Keywords: augmentation; macrogol; osmotic laxative.
© 2019 Alfred Health, Melbourne. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Sodium Picosulfate/Magnesium Citrate: A Review of Its Use as a Colorectal CleanserSM Hoy et al. Drugs 69 (1), 123-36. PMID 19192941. - ReviewOral sodium picosulfate/magnesium citrate (CitraFleet; Picolax), consisting of sodium picosulfate (a stimulant laxative) and magnesium citrate (an osmotic laxative), is a …
Randomized Controlled Trial Comparing Efficacy and Acceptability of Split- And Standard-Dose Sodium Picosulfate Plus Magnesium Citrate for Bowel Cleansing Prior to ColonoscopyG Manes et al. Endoscopy 46 (8), 662-9. PMID 25019969. - Randomized Controlled TrialThe split-dose regimen of PMC was superior to the standard regimen in terms of effective colon cleansing and compliance.ClinicalTrial.gov (NCT01909219).
Single-day Sodium Picosulfate and Magnesium Citrate Versus Split-Dose Polyethylene Glycol for Bowel Cleansing Prior to Colonoscopy: A Prospective Randomized Endoscopist-Blinded TrialP Klare et al. J Gastroenterol Hepatol 30 (11), 1627-34. PMID 25968966. - Randomized Controlled TrialStandard picosulfate/magnesium citrate is better accepted than a split-dose PEG regimen. From the perspective of successful preparation and patients' safety, PEG is super …
A Prospective Audit of the Efficacy, Safety, and Acceptability of Low-Volume Polyethylene Glycol (2 L) Versus Standard Volume Polyethylene Glycol (4 L) Versus Magnesium Citrate Plus Stimulant Laxative as Bowel Preparation for ColonoscopyNM Kelly et al. J Clin Gastroenterol 46 (7), 595-601. PMID 22334219. - Clinical TrialIn summary, low-volume PEG (Moviprep) and Senna/Citramag combination were better tolerated than large volume PEG with Senna/Citramag providing superior mucosal cleansing. …
Management of Faecal Incontinence and Constipation in Adults With Central Neurological DiseasesM Coggrave et al. Cochrane Database Syst Rev (1), CD002115. PMID 24420006. - ReviewThere is still remarkably little research on this common and, to patients, very significant issue of bowel management. The available evidence is almost uniformly of low m …
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