Comparison of sulfate-based solution and polyethylene glycol solution for bowel cleansing before colonoscopy - randomized, single-blind study
Abstract
Background: Adequate bowel cleansing is a fundamental requisite for proper colonoscopy examinations. Among bowel preparations, polyethylene glycol (PEG) is the gold standard, but requires large volumes of solution.
Low-volume preparations could provide an alternative to PEG. A Czech randomized single blind study compared the efficiency of a low-volume sulfate-based solution (SBS) with that of PEG.
Aim: To compare the quality of bowel cleansing and detection of colorectal neoplasia after cleansing with SBS and PEG solutions. Method: Individuals who had undergone colonoscopy screening in a single tertiary endoscopic center were enrolled in this randomized single-blind study.
All individuals were consistently educated about the split dose regimen. The quality of bowel cleansing was evaluated by endoscopists who were blinded to the type of bowel preparation.
The effectiveness of bowel preparation was assessed by the degree of bowel cleansing (modified Boston scale, levels A-D) and by the detection rate of colorectal neoplasia. Results: In the period May 2015 to June 2016, 462 individuals were included in the study.
PEG was employed in 233. SBS was employed in 229.
Bowel cleansing by SBS and PEG was similar (PEG 97% vs. SBS 94%; p = 0.197).
However, quality of bowel cleansing was better with split dose bowel preparation (PEG 97 vs. 93%, p = 0.263; SBS 96 vs. 81%, p = 0.006). A significant difference was observed between split dose and single dose preparations in the SBS group (PEG 70 vs. 59%, p = 0.284; SBS 75 vs. 28%, p < 0.001).
Detection of colorectal neoplasia was comparable between the two groups: adenoma (PEG 39 vs. 44%; p = 0.346), advanced adenoma (6% PEG vs. 7% SS; p = 1.000), and carcinoma (0.4% PEG vs. 0.4% SS). Conclusion: A low-volume solution of sulfate salts is as effective as PEG for colon screening by colonoscopy.