Abstract
Comparative Efficacy of Sodium Picosulfate, Polyethylene Glycol, and Lactitol Monohydrate as Bowel Preparation for Colonoscopy: A Randomized Controlled Study
Salahuddin C. Andam, MD; Erika P. Tanada, MD; Maria Hossea C. Monfero, MD; Marie Luciene S. Diezmos, MD; John Michael Joseph M. Napa, MD; Alvin C. Velasco, MD; Rommel Romano, MD; Carmelita D. Dalupang, MD; Estrellita J. Ruiz, MD; Melchor M. Chan, MD; Michael Louie M. Lim, MD; Stephen N. Wong, MD; Frederick T. Dy, MD
University of Santo Tomas Hospital
Significance: The clinical value of colonoscopy is contingent on optimal bowel preparation. Sodium picosulfate/magnesium oxide/citric acid (SPMC), polyethylene glycol (PEG), and lactitol monohydrate are commonly used agents, each with distinct efficacy and tolerability profiles. Conflicting evidence about their relative effectiveness necessitates further investigation.
Methodology: A single-center, prospective, randomized controlled trial conducted between July 2024 and January 2025. Randomization was performed using sealed envelopes and computer-generated allocation, with blinding of outcome assessors. Patients aged ?18 years scheduled for elective colonoscopy were included. Exclusion criteria included prior bowel resection, chronic kidney disease, and emergency indications. Participants were assigned to receive SPMC, PEG, or lactitol monohydrate, with adjunct 20mg bisacodyl. The Boston Bowel Preparation Scale (BBPS), Colon Endoscopic Bubble Scale, and cecal intubation rate were assessed. Data were analyzed using SPSS v28, employing Tukey HSD and chi-square tests.
Results: A total of 213 patients were randomized to SPMC(N=71), PEG(N=71) and Lactitol Monohydrate(N=71), with no drop-outs reported. There were no differences in baseline characteristics between the 3 groups. The mean BBPS scores were 8.16 (SPMC), 7.98 (PEG), and 7.74 (lactitol), with no significant differences among groups (p > 0.05). Bubble scores were 0.38 (SPMC), 0.32 (PEG), and 0.42 (lactitol) (p > 0.05). Cecal intubation success rates were 100% for lactitol and 94% for both SPMC and PEG (p > 0.05).
Conclusion: SPMC, PEG, and lactitol monohydrate exhibited comparable efficacy, with no significant differences in bowel cleanliness, bubble formation, or cecal intubation rates. These findings may expand our bowel preparation options based on individual patient preferences, tolerability, and cost.SPMC, PEG, and lactitol monohydrate exhibited comparable efficacy, with no significant differences in bowel cleanliness, bubble formation, or cecal intubation rates. These findings may expand our bowel preparation options based on individual patient preferences, tolerability, and cost.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |