BACKGROUND: Regulatory agencies have warned clinicians regarding the risk of electrolyte abnormalities if more than two 45-mL bottles of oral sodium phosphate (NaP) solution are administered within a 24-hour period. OBJECTIVE: To compare the efficacy, safety, and tolerability of different regimens of oral NaP and polyethylene glycol (PEG). DESIGN: Randomized controlled trial. SETTING:Teaching hospital outpatient endoscopy clinic. PATIENTS: Two hundred outpatients without comorbidities who underwent routine colonoscopy. INTERVENTIONS: Two bottles of NaP, 6, 12, or 24 hours apart; or 4 L PEG. MAIN OUTCOME MEASUREMENTS: Bowel preparation quality, patient tolerability, and electrolyte changes. RESULTS: The 12- and 24-hour NaP achieved better cleansing than the 6-hour NaP or PEG. Only 8.5% and 8.3% of patients in the 24- and 12-hour NaP had poor preparations, respectively, compared with 15.6% and 23.4% in the 6-hour NaP and PEG, respectively. The poorer preparation scores with PEG were partly because of a greater amount of colonic fluid. There were no relevant electrolyte changes with PEG, whereas hypokalemia, hypocalcemia, or hyperphosphatemia developed in 5% to 57% of patients on NaP. All regimens were poorly tolerated by patients. LIMITATIONS: The study was likely underpowered to detect small group differences in electrolytes. CONCLUSIONS: A 24- or 12-hour NaP bowel preparation strategy was more effective than NaP 6 hours apart or PEG. PEG use is associated with more residual colonic fluid but represents an alternative to NaP in some clinical situations.
RCT Entities:
BACKGROUND: Regulatory agencies have warned clinicians regarding the risk of electrolyte abnormalities if more than two 45-mL bottles of oral sodium phosphate (NaP) solution are administered within a 24-hour period. OBJECTIVE: To compare the efficacy, safety, and tolerability of different regimens of oral NaP and polyethylene glycol (PEG). DESIGN: Randomized controlled trial. SETTING: Teaching hospital outpatient endoscopy clinic. PATIENTS: Two hundred outpatients without comorbidities who underwent routine colonoscopy. INTERVENTIONS: Two bottles of NaP, 6, 12, or 24 hours apart; or 4 L PEG. MAIN OUTCOME MEASUREMENTS: Bowel preparation quality, patient tolerability, and electrolyte changes. RESULTS: The 12- and 24-hour NaP achieved better cleansing than the 6-hour NaP or PEG. Only 8.5% and 8.3% of patients in the 24- and 12-hour NaP had poor preparations, respectively, compared with 15.6% and 23.4% in the 6-hour NaP and PEG, respectively. The poorer preparation scores with PEG were partly because of a greater amount of colonic fluid. There were no relevant electrolyte changes with PEG, whereas hypokalemia, hypocalcemia, or hyperphosphatemia developed in 5% to 57% of patients on NaP. All regimens were poorly tolerated by patients. LIMITATIONS: The study was likely underpowered to detect small group differences in electrolytes. CONCLUSIONS: A 24- or 12-hour NaP bowel preparation strategy was more effective than NaP 6 hours apart or PEG. PEG use is associated with more residual colonic fluid but represents an alternative to NaP in some clinical situations.
Authors: Grace Clarke Hillyer; Benjamin Lebwohl; Corey H Basch; Charles E Basch; Fay Kastrinos; Beverly J Insel; Alfred I Neugut Journal: Therap Adv Gastroenterol Date: 2013-01 Impact factor: 4.409
Authors: Brian L Lyons; Mark A Korsten; Ann M Spungen; Miroslav Radulovic; Alan S Rosman; Kristel Hunt; Marinella D Galea; Stephen D Kornfeld; Christina Yen; William A Bauman Journal: J Spinal Cord Med Date: 2014-08-06 Impact factor: 1.985
Authors: M A Korsten; A M Spungen; A R Rosman; H R Ancha; J B Post; S Shaw; K K Hunt; R Williams; W A Bauman Journal: Dig Dis Sci Date: 2009-10-16 Impact factor: 3.199