Brief Article
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World J Gastroenterol. Sep 7, 2013; 19(33): 5493-5499
Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5493
Bisacodyl plus split 2-L polyethylene glycol-citrate-simethicone improves quality of bowel preparation before screening colonoscopy
Flavio Valiante, Angelo Bellumat, Manuela De Bona, Michele De Boni
Flavio Valiante, Angelo Bellumat, Manuela De Bona, Michele De Boni, Department of Gastroenterology and Digestive Endoscopy, S Maria del Prato Hospital, Feltre, 32032 Belluno, Italy
Author contributions: Valiante F designed research; Valiante F, Bellumat A, De Bona M and De Boni M performed research; Valiante F analyzed data; Valiante F and De Boni M wrote the paper.
Correspondence to: Flavio Valiante, MD, Department of Gastroenterology and Digestive Endoscopy, S Maria del Prato Hospital, Via Bagnols sur Ceze 3, Feltre, 32032 Belluno, Italy. flavio.valiante@gmail.com
Telephone: +39-45-8036052 Fax: +39-45-8067686
Received: April 29, 2013
Revised: May 24, 2013
Accepted: June 19, 2013
Published online: September 7, 2013
Processing time: 132 Days and 15.2 Hours
Abstract

AIM: To compare the bowel cleansing efficacy, tolerability and acceptability of split 2-L polyethylene glycol (PEG)-citrate-simethicone (PEG-CS) plus bisacodyl (BIS) vs 4-L PEG for fecal occult blood test-positive screening colonoscopy.

METHODS: This was a randomised, observer-blind comparative study. Two hundred and sixty-four subjects underwent screening colonoscopy (mean age 62.5 ± 7.4 years, male 61.7%). The primary objective of the study was to compare the bowel cleansing efficacy of the two preparations. Interventions: BIS plus PEG-CS: 3 tablets of 5-mg BIS at 16:00, PEG-CS 1-L at 19:00 and 1-L at 7:00, 4-L PEG: 3-L at 17:00, and 1-L at 7:00. Colonoscopy was carried out after 11:00, at least 3 h after the completion of bowel preparation. Bowel cleansing was evaluated using the Harefield Cleansing Scale.

RESULTS: Bowel preparation was successful for 92.8% of subjects in the PEG-CS group and for 92.1% of subjects in the 4-L PEG (RR = 1.01; 95%CI: 0.94-1.08). BIS + PEG-CS was better tolerated than 4-L PEG. A greater rate of patients in the BIS + PEG-CS group had no difficulty and/or were willing to repeat the same preparation compared to split-dose 4-L PEG group. Subjects in the BIS + PEG-CS group rated the prep as good or satisfactory in 90.6% as compared to 77% in the 4-L PEG (P = 0.003). Subjects receiving BIS + PEG-CS stated they fully adhered to instructions drinking all the 2-L solution in 97.1% compared with 87.3% in the 4-L PEG (P = 0.003).

CONCLUSION: BIS plus split 2-L PEG-CS was as effective as but better tolerated and accepted than split 4-L PEG for screening colonoscopy. This new procedure may increase the positive attitude and participation to colorectal cancer screening colonoscopy.

Keywords: Colonoscopy; Colon cleansing; Bowel preparations; Polyethylene glycol; Simethicone; Bisacodyl

Core tip: Colorectal cancer ranks as the most common newly-diagnosed cancer in Europe and the second most common cause of cancer death in Europe. A new colon cleansing procedure based on bisacodyl plus polyethylene glycol (PEG) with citrates and simethicone administered as split dose has the same efficacy but superior tolerability and acceptance to split conventional 4-L PEG. This new procedure may increase the positive attitude and participation to colorectal cancer screening colonoscopy.