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Maeda N, Higashimori A, Nakatani M, Jinnai K, Kin D, Sugita N, Morimoto K, Sasaki E, Fukuda T, Fujiwara Y. Efficacy and tolerability of 1 L polyethylene glycol plus ascorbic acid with senna versus 2 L polyethylene glycol plus ascorbic acid for colonoscopic bowel preparation: Prospective, randomized, investigator-blinded trial. Dig Endosc 2023; 35:767-776. [PMID: 36567637 DOI: 10.1111/den.14504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Low-volume polyethylene glycol plus ascorbic acid (PEG-Asc) reduces the dosage of colonoscopic bowel preparation (BP) solution, but is still poorly tolerated. Adding laxatives to the BP solution reduces the volume of fluid required, without affecting quality. This study aimed to compare 1 L PEG-Asc plus 24 mg senna (1L-PEG/AS) and conventional 2 L PEG-Asc (2L-PEG/A) regimens on BP quality and patient tolerability. METHODS A single-center, randomized, investigator-blinded, noninferiority trial was performed between June and August 2022. Outpatients scheduled for colonoscopy were randomized (1:1) to the 1L-PEG/AS or 2L-PEG/A group. The Boston Bowel Preparation Scale (BBPS) was used to evaluate BP quality. Adverse events and tolerability were surveyed using questionnaires. RESULTS Overall, 344 patients received 1L-PEG/AS or 2L-PEG/A regimens. The baseline characteristics and adverse events of the two groups were comparable. The 1L-PEG/AS group showed noninferior adequate BP rates compared with the 2L-PEG/A group (88% vs. 89%, P = 1.00); overall BBPS was 7.1 ± 1.5 and 7.2 ± 1.5, respectively (P = 0.39). Higher willingness to repeat the BP was observed in the 1L-PEG/AS group (85% vs. 62%, P < 0.01). CONCLUSIONS The 1L-PEG/AS regimen was comparable to the 2L-PEG/A regimen in terms of BP adequacy, requiring lower BP solution volumes, with better patient tolerance. Thus, it may be a suitable alternative to the conventional BP solution for colonoscopy. The Japan Registry of Clinical Trials (jRCT1051220043).
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Affiliation(s)
- Natsumi Maeda
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Akira Higashimori
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Masami Nakatani
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Kagami Jinnai
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Daiyu Kin
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Naoko Sugita
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Kenichi Morimoto
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Eiji Sasaki
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Takashi Fukuda
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Pan H, Zheng XL, Fang CY, Liu LZ, Chen JS, Wang C, Chen YD, Huang JM, Zhou YS, He LP. Same-day single-dose vs large-volume split-dose regimens of polyethylene glycol for bowel preparation: A systematic review and meta-analysis. World J Clin Cases 2022; 10:7844-7858. [PMID: 36158495 PMCID: PMC9372824 DOI: 10.12998/wjcc.v10.i22.7844] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/11/2021] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Split-dose regimens (SpDs) of 4 L of polyethylene glycol (PEG) have been established as the “gold standard” for bowel preparation; however, its use is limited by the large volumes of fluids required and sleep disturbance associated with night doses. Meanwhile, the same-day single-dose regimens (SSDs) of PEG has been recommended as an alternative; however, its superiority compared to other regimens is a matter of debate.
AIM To compare the efficacy and tolerability between SSDs and large-volume SpDs PEG for bowel preparation.
METHODS We searched MEDLINE/PubMed, the Cochrane Library, RCA, EMBASE and Science Citation Index Expanded for randomized trials comparing (2 L/4 L) SSDs to large-volume (4 L/3 L) SpDs PEG-based regimens, regardless of adjuvant laxative use. The pooled analysis of relative risk ratio and mean difference was calculated for bowel cleanliness, sleep disturbance, willingness to repeat the procedure using the same preparation and adverse effects. A random effects model or fixed-effects model was chosen based on heterogeneity analysis among studies.
RESULTS A total of 18 studies were included. There was no statistically significant difference of adequate bowel preparation (relative risk = 0.97; 95%CI: 0.92-1.02) (14 trials), right colon Boston Bowel Preparation Scale (mean difference = 0.00; 95%CI: -0.04, 0.03) (9 trials) and right colon Ottawa Bowel Preparation Scale (mean difference = 0.04; 95%CI: -0.27, 0.34) (5 trials) between (2 L/4 L) SSDs and large-volume (4 L/3 L) SpDs, regardless of adjuvant laxative use. The pooled analysis favored the use of SSDs with less sleep disturbance (relative risk = 0.52; 95%CI: 0.40, 0.68) and lower incidence of abdominal pain (relative risk = 0.75; 95%CI: 0.62, 0.90). During subgroup analysis, patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation than SpDs (P < 0.05). No significant difference in adverse effects, including nausea, vomiting and bloating, was found between the two arms (P > 0.05).
CONCLUSION Regardless of adjuvant laxative use, the (2 L/4 L) SSD PEG-based arm was considered equal or better than the large-volume (≥ 3 L) SpDs PEG regimen in terms of bowel cleanliness and tolerability. Patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation due to the low-volume fluid requirement and less sleep disturbance.
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Affiliation(s)
- Hui Pan
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital, The Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Xiao-Ling Zheng
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital, The Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Chao-Ying Fang
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Lan-Zai Liu
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Jian-Su Chen
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Chao Wang
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Yu-Dai Chen
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Jian-Min Huang
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Yu-Shen Zhou
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Li-Ping He
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
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van Riswijk MLM, van Keulen KE, Siersema PD. Efficacy of ultra-low volume (≤1 L) bowel preparation fluids: Systematic review and meta-analysis. Dig Endosc 2022; 34:13-32. [PMID: 33991373 PMCID: PMC9290948 DOI: 10.1111/den.14015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS High-quality bowel preparation is paramount for the diagnostic accuracy and safety of colonoscopy; however, it is often difficult for patients to adhere to high-volume laxatives, which may contribute to poor bowel preparation. This review aims to assess the efficacy of bowel preparation fluids of 1 L or less (≤1 L). METHODS We performed a systematic review including all relevant randomized controlled trials on ultra-low volume (≤1 L) bowel preparation fluids for colonoscopy published since 2015. Primary endpoint was the percentage of adequately prepared patients. Secondary endpoints included adenoma detection rate (ADR) and safety. RESULTS Bowel preparation with sodium picosulfate/magnesium citrate (SPMC; 19 trials, n = 10,287), 1L-polyethylene glycol with ascorbate (PEGA; 10 trials, n = 1717), sodium phosphate (NaP; 2 trials, n = 621), and oral sulfate solution (OSS; 3 trials, n = 597) was adequate in 75.2%, 82.9%, 81.9%, and 92.1%, respectively, of patients; however, heterogeneity between studies was considerable (I2 range: 86-98%). Pooled ADRs were 31.1% with SPMC, 32.3% with 1L-PEGA, 30.4% with NaP, and 40.9% with OSS. Temporary electrolyte changes were seen with all ultra-low volume bowel preparation fluid solutions but without sustained effects in most patients. CONCLUSION Ultra-low volume bowel preparation fluids do not always meet the 90% quality standard for adequate bowel preparation as defined by current guidelines. Nonetheless, they may be considered in patients intolerant for higher-volume laxatives and without risk factors for inadequate bowel preparation or dehydration-related complications.
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Affiliation(s)
- Milou L. M. van Riswijk
- Department of Gastroenterology and HepatologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - Kelly E. van Keulen
- Department of Gastroenterology and HepatologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - Peter D. Siersema
- Department of Gastroenterology and HepatologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
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Søfteland JM, Bagge J, Padma AM, Casselbrant A, Zhu C, Wang Y, Hellström M, Olausson M, Oltean M. Luminal polyethylene glycol solution delays the onset of preservation injury in the human intestine. Am J Transplant 2021; 21:2220-2230. [PMID: 33249756 DOI: 10.1111/ajt.16418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/12/2020] [Accepted: 11/13/2020] [Indexed: 01/25/2023]
Abstract
The organ damage incurred during the cold storage (CS) of intestinal grafts has short and long-term consequences. Animal studies suggest that additional luminal preservation (LP) with polyethylene glycol (PEG) may alleviate this damage. This study aims to validate these findings using human intestines. Ileal segments, perfused intravascularly with IGL-1 solution, were procured from 32 multiorgan donors and divided into two parts: one containing a PEG 3350-based solution introduced luminally (LP group) and another one without luminal treatment (control). Sampling was performed after 4 h, 8 h, 14 h, and 24 h of CS. Histology was assessed using the Chiu/Park score. Tight junctions (TJ), several inflammatory markers, and transcription factors were examined by immunofluorescence, ddPCR, and western blot. Tissue water content (edema) was also measured. Apoptotic activity was assessed with caspase -2, -3, and -9 assays. LP significantly lowered mucosal injury at all time points. Redistribution of TJ proteins occurred earlier and more severely in the control group. After 24 h of CS, LP intestines showed an emerging unfolding protein response. Increased caspase-3 and -9 activity was found in the control group. The current results indicate that luminal PEG is safe and effective in reducing damage to the intestinal epithelium during CS.
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Affiliation(s)
- John M Søfteland
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jasmine Bagge
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Arvind M Padma
- Institute of Clinical Sciences, Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Casselbrant
- Institute of Clinical Sciences, Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Changlian Zhu
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yafeng Wang
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mats Hellström
- Institute of Clinical Sciences, Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Olausson
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mihai Oltean
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Yuan X, Zhang Z, Xie J, Zhang Y, Xu L, Wang W, Xu L. Comparison of 1L Adjuvant Auxiliary Preparations with 2L Solely Polyethylene Glycol plus Ascorbic Acid Regime for Bowel Cleaning: A Meta-analysis of Randomized, Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6638858. [PMID: 33681359 PMCID: PMC7910058 DOI: 10.1155/2021/6638858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/26/2021] [Accepted: 02/10/2021] [Indexed: 12/31/2022]
Abstract
The effectiveness of additional usage of adjuvants for bowel preparation is still unclear. This study compared 1L polyethylene glycol plus ascorbic acid with adjuvant drug regimens (1L PEG-AA, lower volume) with 2L polyethylene glycol plus ascorbic acid (2L PEG-A, low volume) to evaluate whether the adjuvants can be used to reduce the standard dosage of purgative further. The PubMed/MEDLINE, EMBASE, Cochrane Library, and Web of Science database were searched for randomized controlled trials (RCTs). The primary outcome was the efficacy of bowel preparation, and the secondary outcomes were patients' tolerability and complication rate. The overall quality of evidence was assessed using the GRADEpro guideline development tool. Five RCTs with a total of 1013 patients from Korea were included. The majority of patients were outpatients from different hospitals. The pooled data showed no significant difference in the adequate bowel preparation rate (89.3% versus 89.4%, RR 1, 95% CI 0.95-1.05, I 2 = 47%) as well as in the complication rate (RR for nausea 1.22, 95% CI 0.89-1.65, I 2 = 49%; RR for bloating 0.96, 95% CI 0.73-1.28, I 2 = 0%; RR for vomiting 0.69, 95% CI 0.32-1.50, I 2 = 33%; RR for abdominal pain 1.01, 95% CI 0.61-1.69, I 2 = 0%). But a significantly higher willingness rate was observed in the lower volume (85.1% versus 67.9%, RR 1.25, 95% CI 1.14-1.38, I 2 = 46%). The quality of primary outcome evidence was moderate. The findings of this meta-analysis revealed that 1L PEG-AA may be a viable alternative to 2L PEG-A, with comparable effectiveness, better patient preference, and no statistically significant adverse event occurrence.
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Affiliation(s)
- Xin Yuan
- College of Medicine, Ningbo University, Zhejiang, China
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Zhixin Zhang
- College of Medicine, Ningbo University, Zhejiang, China
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Jiarong Xie
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Yu Zhang
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Lu Xu
- Clinical Department for Intensive Care, Ningbo No.2 Hospital, Zhejiang, China
| | - Weihong Wang
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Lei Xu
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
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Park SW, Shin SP, Hong JT. Efficacy and Tolerability of Prucalopride in Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis. Adv Ther 2020; 37:2507-2519. [PMID: 32323193 DOI: 10.1007/s12325-020-01333-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Adequate bowel preparation is a vital determinant for the success of colonoscopy. However, individuals who undergo bowel preparation for colonoscopy can experience major discomfort. To solve this problem, adding prucalopride to the prepared solution may reduce intake volume, decreasing discomfort and side effects. We performed meta-analyses and systematic review of available randomized controlled trials. METHODS Meta-analyses were conducted to evaluate the overall relative risk and 95% confidence intervals in the combined studies for the assessment of primary outcome, which is the efficacy of bowel preparation with the addition of prucalopride. RESULTS Four randomized controlled trials involving 581 patients were included. When data were pooled for all patients in two non-inferiority studies, no significant difference in the quality of bowel preparation was observed between patients receiving prucalopride plus bowel preparation solution at a lower volume and those receiving the existing solution (relative risk: 0.94; 95% confidence interval: 0.86-1.03). The effects of prucalopride on acceptability, adverse events, adenoma detection rate, and polyp detection rate did not significantly differ from those of traditional solutions. CONCLUSIONS The combination of prucalopride and bowel preparation solution at a lower volume has similar effects on bowel preparation, and its use did not increase the occurrence of adverse effects.
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Affiliation(s)
- Sung-Wook Park
- Department of Internal Medicine, Nasaret International Hospital, Incheon, Korea
| | - Seok-Pyo Shin
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Ji Taek Hong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
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