Mechanical colon cleansing for screening colonoscopy: a randomized controlled trial

ABSTRACT

Aims

Effective screening colonoscopy depends on the quality of colon preparation. To compare pulsed irrigation evacuation (PIE), polyethylene glycol (PEG) and sodium phosphate colon preps.

Methods

Outpatients at a VA hospital were randomized using sealed envelopes. Preparations consisted of: 4 liters Golytely; 90 mL of Fleet sodium phosphate with 4-6 glasses water b.i.d., and 296 mL of Mg citrate in the evening with PIE prior to colonoscopy. Colon cleansing was assessed blindly using a 5-point scale: 0 = very poor to 4 = excellent.

Results

391 patients participated (PEG = 129, sodium phosphate = 127, PIE = 135); mean age: 62 years, 75% men. PIE and sodium phosphate were superior to PEG: median cleansing = 4 (excellent) vs. 3 with PEG (p <0.01). Inadequate preps were more common with PEG than PIE (18% vs. 5%) (p <0.01). Side effects including: vomiting: 37% with the sodium phosphate vs. 5% with PEG and 2% with PIE (p<0.01). The 3 preps were judged as intolerable in <5%.

Conclusions

PIE and sodium phosphate were superior to PEG for colon preparations. PIE would be the preferred preparation for those at high risk for unsatisfactory preparations or with unsatisfactory traditional preparations.

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