Abstract
Lactulose vs. Polyethylene Glycol as Bowel Preparation Agent for Colonoscopy
Jan Bendric C. Borbe, MD; Glen Aldrix Anarna, MD; Anton Elepaño, MD; Eric Yasay, MD
University of the Philippines – Philippine General Hospital
Significance: Good bowel preparation is one of the key indicators of a high quality colonoscopy. While polyethylene glycol (PEG) is the established standard for bowel cleansing, its requirement for large volumes and associated poor tolerability can hinder patient compliance. Lactulose, a non-absorbable disaccharide laxative, has emerged as a promising alternative due to its palatability and favorable safety profile. This study aims to compare lactulose with PEG as a bowel preparation agent for colonoscopy.
Methodology: A literature search for randomized controlled trials comparing lactulose versus PEG among adult patients who underwent bowel preparation for colonoscopy. The primary outcome of interest was the quality of bowel preparation using validated scales. Secondary outcomes were polyp detection rate, tolerability, and adverse effects. Three independent reviewers were involved in study selection, data collection, and risk of bias assessment.
Results: A total of 3 studies were included in the quantitative analysis. Pooled analysis revealed that the lactulose group had higher bowel preparation scores compared to PEG with a standardized mean difference of 0.56 (p=0.01). Polyp detection rates were higher in the lactulose group, although not statistically significant (odds ratio 1.73, p=0.06). Adverse effects were reported across all studies, with nausea and vomiting being the most common.
Conclusion: Lactulose appears to be a safe and effective alternative to PEG for bowel preparation prior to colonoscopy as it offers improved cleansing efficacy and comparable polyp detection rates. These findings suggest that lactulose could be considered a viable option in settings where PEG is less accessible or tolerated.
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 |