Brief Article
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World J Gastroenterol. Nov 14, 2011; 17(42): 4689-4695
Published online Nov 14, 2011. doi: 10.3748/wjg.v17.i42.4689
Low-volume plus ascorbic acid vs high-volume plus simethicone bowel preparation before colonoscopy
Stefano Pontone, Rita Angelini, Monica Standoli, Gregorio Patrizi, Franco Culasso, Paolo Pontone, Adriano Redler
Stefano Pontone, Rita Angelini, Monica Standoli, Gregorio Patrizi, Paolo Pontone, Adriano Redler, Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Roma, Italy
Franco Culasso, Department of Medical Statistics, “Sapienza” University of Rome, 00161 Roma, Italy
Author contributions: Pontone S contributed to acquisition, analysis and interpretation of data, and study concept and design; Pontone P, Angelini R, Standoli M and Patrizi G contributed to acquisition of data; Culasso F contributed to statistical analysis; Pontone P and Redler A contributed to critical revision of the manuscript for important intellectual content.
Correspondence to: Dr. Stefano Pontone, Department of Surgical Sciences, “Sapienza” University of Rome, V le Regina Elena 324, 00161 Rome, Italy.
Telephone: +39-06-49972446 Fax: +39-06-49972446
Received: April 4, 2011
Revised: June 15, 2011
Accepted: June 22, 2011
Published online: November 14, 2011

AIM: To investigate the effectiveness of low-volume plus ascorbic acid [polyethylene glycol plus ascorbic acid (PEG + Asc)] and high-volume plus simethicone [polyethylene glycol plus simethicone (PEG + Sim)] bowel preparations.

METHODS: A total of one hundred and forty-four outpatients (76 males), aged from 20 to 84 years (median age 59.5 years), who attended our Department, were divided into two groups, age and sex matched, and underwent colonoscopy. Two questionnaires, one for patients reporting acceptability and the other for endoscopists evaluating bowel cleansing effectiveness according to validated scales, were completed. Indications, timing of examination and endoscopical findings were recorded. Biopsy forceps were used as a measuring tool in order to determine polyp endoscopic size estimation. Difficulty in completing the preparation was rated in a 5-point Likert scale (1 = easy to 5 = unable). Adverse experiences (fullness, cramps, nausea, vomiting, abdominal pain, headache and insomnia), number of evacuations and types of activities performed during preparation (walking or resting in bed) were also investigated.

RESULTS: Seventy-two patients were selected for each group. The two groups were age and sex matched as well as being comparable in terms of medical history and drug therapies taken. Fourteen patients dropped out from the trial because they did not complete the preparation procedure. Ratings of global bowel cleansing examinations were considered to be adequate in 91% of PEG + Asc and 88% of PEG + Sim patients. Residual Stool Score indicated similar levels of amount and consistency of residual stool; there was a significant difference in the percentage of bowel wall visualization in favour of PEG + Sim patients. In the PEG + Sim group, 12 adenomas ≤ 10 mm diameter (5/left colon + 7/right colon) vs 9 (8/left colon + 1/right colon) in the PEG + Asc group were diagnosed. Visualization of small lesions seems to be one of the primary advantages of the PEG + Sim preparation.

CONCLUSION: PEG + Asc is a good alternative solution as a bowel preparation but more improvements are necessary in order to achieve the target of a perfect preparation.

Keywords: Bowel preparation, Polyethylene glycol, Ascorbic acid, Colonoscopy, Simethicone