Split-dose picosulfate better tolerated for bowel cleansing

Reuters Health Information: Split-dose picosulfate better tolerated for bowel cleansing

Split-dose picosulfate better tolerated for bowel cleansing

Last Updated: 2018-04-23

By Will Boggs MD

NEW YORK (Reuters Health) - Split-dose picosulfate is better tolerated than 2-1 polyethylene glycol (PEG) for bowel cleansing before colonoscopy, researchers from the Netherlands report.

"A good colon preparation is one side of the coin, but the other one is the way patients perceive the burden of the preparation and the interference with daily activities and night sleep, which may stimulate them to comply with the preparation," Dr. Elisabeth M. H. Mathus-Vliegen from Academic Medical Center at the University of Amsterdam told Reuters Health by email.

Smaller-volume preparations (like 2-1 PEG solution) and saline laxatives (like picosulfate) are as effective as previous bowel-cleansing methods and show better tolerability. Whether a small-volume picosulfate preparation is equally effective had not been studied before the new work.

Dr. Mathus-Vliegen's team compared a small-volume picosulfate formulation with a 2-1 PEG solution plus bisacodyl, both in split-dose schedules, in a randomized noninferiority trial of 354 patients scheduled for colonoscopy.

Every patient in the picosulfate group and 95.5% of patients in the PEG plus bisacodyl group completed intake of the preparation as prescribed. Patients in the picosulfate group took 0.6% less than the prescribed 4,300 mL (including clear fluid), whereas patients in the PEG group took 16% more than the prescribed 4,000 mL.

Adequate bowel cleansing (as defined by an Ottawa Bowel Preparation Quality Scale score of 7 or lower) was achieved by 68.4% of picosulfate patients and 71.8% of PEG patients, a noninferior difference, the researchers report in the European Journal of Gastroenterology & Hepatology, online April 10.

Complaints of nausea, chills or feeling cold, bloating, and overall symptoms were more frequent in the PEG group than in the picosulfate group.

Patients rated the ease of intake and taste of the solution significantly better for the picosulfate preparation.

More patients in the picosulfate group (93.6%) than in the PEG group (59.7%) said they would choose the same preparation again for a repeat colonoscopy.

"A split-dose schedule was possible even for those who had their colonoscopy at 8:30 am in both arms, which meant that patents had to get up early, sometimes even at 4 or 5 am," Dr. Mathus-Vliegen said. "Similar to our two previous studies, patients preferred to have a small volume of less tasteful-tasting solution (300 mL) instead of a 2 L less-tasteful-tasting solution, regardless the fact that still a large volume of normal fluids were necessary (a respective 4 L and 2 L clear fluids)."

"Probably the combination of bisacodyl (2 days before as with Moviprep, a PEG preparation) with Picoprep (a picosulfate preparation) might be the best choice," she concluded.

Ferring BV, manufacturer of the picosulfate formulation used, reimbursed the laboratory measurements of the patients included in the trial.

SOURCE: https://bit.ly/2HojHMm

Eur J Gastroenterol Hepatol 2018.

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