Are sodium phosphate tablets better than polyethylene glycol solution plus bisacodyl tablets for bowel preparation?

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Abstract

BACKGROUND

Bowel preparation has been identified as a deterrent for undergoing screening colonoscopy.

OBJECTIVE

To evaluate and compare patient tolerability, acceptance and preference of bowel preparation with sodium phosphate tablets with that of polyethylene glycol (PEG) solution plus bisacodyl tablets for screening colonoscopy.

DESIGN AND INTERVENTION

This multicenter, prospective, randomized study included patients who were scheduled to undergo colonoscopy. Exclusion criteria included renal insufficiency, serum electrolyte abnormalities and severe chronic constipation. Patients were randomly allocated to bowel preparation with sodium phosphate (NaP) tablets (32 tablets each containing 48 g of NaP) or PEG solution (2 l) plus bisacodyl tablets (4 tablets each containing 20 mg of bisacodyl). Those patients who received NaP tablets were instructed to take 20 tablets at 1800 h on the evening before colonoscopy, with the remaining 12 tablets taken 3-5 h before colonoscopy. Tablets were taken 4 at a time at 15 min intervals with 240 ml of any clear liquid. Patients in the PEG group were instructed to take 4 bisacodyl tablets with water at 1200 h on the day before colonoscopy and then 2 l of PEG solution (one 240 ml glass every 10 min) after a bowel movement or ≤6 h later. Patients in the NaP group were required to eat a light breakfast before 1200 h on the day of colonoscopy consisting of pulp-free beverages, low fiber and low fat foods. These patients could drink only clear liquids after 1200 h. Patients in the PEG group were instructed to drink only clear liquids on the day before and the day of colonoscopy. All patients completed a standardized questionnaire that assessed patient acceptance, tolerability, preference, and compliance before being sedated for colonoscopy.

OUTCOME MEASURES

The main outcome measures were patient acceptance, tolerability, preference and compliance, and the incidence of gastro intestinal adverse effects.

RESULTS

A total of 411 patients received bowel preparation and completed the study questionnaire (205 patients received NaP tablets and 206 received PEG solution plus bisacodyl tablets). Significantly more patients in the NaP group than the PEG group reported that their bowel preparation was without taste (47% versus 6%), easy to take (77% versus 42%), easy to take with regard to the amount of volume of liquid required to drink (72% versus 27%), and indicated that they would be willing to take the treatment again in the future (95% versus 74%), P <0.0001 for all comparisons. Furthermore, significantly fewer patients in the NaP group than the PEG group had to change their activities or take time off work because of bowel preparation (18% versus 52%; P <0.0001). Gastrointestinal adverse effects were reported significantly less frequently by patients in the NaP group than by those in the PEG group.

CONCLUSION

Bowel preparation with NaP tablets seems to be better tolerated by patients and easier to take than PEG solution plus bisacodyl tablets.

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