Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2021; 9(15): 3586-3596
Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3586
Cleansing efficacy and safety of bowel preparation protocol using sodium picosulfate/magnesium citrate considering subjective experiences: An observational study
Fang-Xun Liu, Li Wang, Wen-Jie Yan, Li-Chun Zou, Yue-An Cao, Xiang-Chun Lin
Fang-Xun Liu, Wen-Jie Yan, Li-Chun Zou, Yue-An Cao, Department of International Medical Center, Peking University International Hospital, Beijing 102206, China
Li Wang, Xiang-Chun Lin, Department of Gastroenterology, Peking University International Hospital, Beijing 102206, China
Author contributions: Liu FX was both the investigator and the designer of the study; Cao YA and Lin XC were involved with study design; Liu FX, Wang L, Yan WJ and Zou LC participated in the acquisition, analysis and interpretation of the data and drafted the initial manuscript; All authors critically revised the article and approved the article for publication.
Supported by Beijing Science and Technology Program, China, Early Endoscopic Diagnosis for Colorectal Cancer—The Guidance Study, No. D17110002617002.
Institutional review board statement: The study was reviewed and approved by the Science and Peking University International Hospital (Beijing).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist-of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yue-An Cao, BMed, Chief Doctor, Department of International Medical Center, Peking University International Hospital, No. 1 Life Park Road, Life Science Park of Zhong Guancun, Changping District, Beijing 102206, China. caoyuean@pkuih.edu.cn
Received: February 4, 2021
Peer-review started: February 4, 2021
First decision: March 7, 2021
Revised: March 17, 2021
Accepted: March 23, 2021
Article in press: March 23, 2021
Published online: May 26, 2021
ARTICLE HIGHLIGHTS
Research background

Bowel cleansing is important for successful colonoscopy, but the ideal clearing agent and volume are yet to be determined in China. A small-volume bowel cleansing agent is important for patient compliance. However, the general bowel preparation regimen in China is based on a large volume of polyethylene glycol.

Research motivation

In China, there is scarce evidence and few studies that observe the bowel cleansing effect of small-volume agents such as sodium picosulfate/magnesium citrate (SPMC). Therefore, to evaluate and optimize the use of SPMC is of important significance for improving patient tolerability during colonoscopy.

Research objectives

We observed bowel cleansing effectiveness and safety as well as patient-centered clinical characteristics, such as the pattern of defecation, acceptance and tolerability during bowel preparation.

Research methods

We included patients who were hospitalized and underwent colonoscopy from April 29 to October 29, 2020. Subjects received SPMC as a bowel cleansing agent. The bowel cleansing effect was evaluated according to the Ottawa Bowel Preparation Scale (OBPS). Defecation conditions and adverse reactions were recorded. The comfort level and subjective satisfaction towards medication were evaluated by the visual analogue scale/score (VAS).

Research results

A total of 64 subjects receiving SPMC were included in the study. The rate of successful bowel preparation (OBPS ≤ 7) was 93.55% in this cohort, with 67.74% showing “excellent” bowel preparation (OBPS ≤ 4). Although the median additional liquid volume was 3000 mL, the median visual analogue score for ease of taking and taste perception of the bowel cleanser was excellent, indicating a well-tolerated profile of SPMC. Univariate analysis and logistic regression analysis for subjects with OBPS > 4 indicated that age and previous constipation were risk factors for a suboptimal bowel cleansing effect.

Research conclusions

The present study indicates that sodium picosulfate with magnesium citrate provides optimal bowel cleansing effects as well as a more positive patient experience regardless of whether they had had a previous colonoscopy experience or not. Enhanced bowel preparation should be considered in elderly patients and constipated patients to improve the bowel cleansing effect.

Research perspectives

The present study is the first large-sample, observational study on patient-centered clinical characteristics after SPMC administration in China, providing evidence for clinical treatment and clinical guidance for subsequent randomized controlled studies.