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Hookey L, Haimanot S, Marchut K, et al. More Is Not Always Better: A Randomized Trial Of Low Volume Oral Laxative, Enemas, And Combination Of Both Demonstrate That Enemas Alone Are Most Efficacious For Preparation For Flexible Sigmoidoscopy. Clin Transl Gastroenterol. 2016;7:e156doi: 10.1038/ctg.2016.15.
Hookey, L., Haimanot, S., Marchut, K., & Vanner, S. (2016). More Is Not Always Better: A Randomized Trial Of Low Volume Oral Laxative, Enemas, And Combination Of Both Demonstrate That Enemas Alone Are Most Efficacious For Preparation For Flexible Sigmoidoscopy. Clinical and translational gastroenterology, 7e156. https://doi.org/10.1038/ctg.2016.15
Hookey, Lawrence, et al. "More Is Not Always Better: A Randomized Trial Of Low Volume Oral Laxative, Enemas, And Combination Of Both Demonstrate That Enemas Alone Are Most Efficacious For Preparation For Flexible Sigmoidoscopy." Clinical and translational gastroenterology vol. 7 (2016): e156. doi: https://doi.org/10.1038/ctg.2016.15
Hookey L, Haimanot S, Marchut K, Vanner S. More Is Not Always Better: A Randomized Trial Of Low Volume Oral Laxative, Enemas, And Combination Of Both Demonstrate That Enemas Alone Are Most Efficacious For Preparation For Flexible Sigmoidoscopy. Clin Transl Gastroenterol. 2016 Mar 17;7:e156. doi: 10.1038/ctg.2016.15. PMID: 26986656; PMCID: PMC4822094.
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Clin Transl Gastroenterol. 2016 Mar 17;7:e156. doi: 10.1038/ctg.2016.15.

More Is Not Always Better: A Randomized Trial Of Low Volume Oral Laxative, Enemas, And Combination Of Both Demonstrate That Enemas Alone Are Most Efficacious For Preparation For Flexible Sigmoidoscopy.

Clinical and translational gastroenterology

Lawrence Hookey, Samson Haimanot, Katherine Marchut, Stephen Vanner

Affiliations

  1. Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada.

PMID: 26986656 PMCID: PMC4822094 DOI: 10.1038/ctg.2016.15

Abstract

OBJECTIVES: Colon cleansing for flexible sigmoidoscopy using a standard fleet enema does not provide adequate cleansing in a significant number of patients. We tested whether the addition of a low-volume oral cleansing agent could mitigate this challenge without significantly compromising patient tolerance.

HYPOTHESIS: Oral picosulfate with magnesium citrate (P/MC) would enhance the colon cleansing of patients undergoing sigmoidoscopy, as assessed by the modified Ottawa Bowel Preparation Score.

METHODS: A randomized single blinded trial comparing (1) a single dose (i.e., one sachet) of oral sodium picosulfate plus magnesium citrate (P/MC) administered the night before, (2) a single dose oral P/MC the night before plus sodium phosphate enema 1 h before leaving home, and (3) sodium phosphate enema alone 1 h before leaving home for flexible sigmoidoscopy was conducted on outpatients referred for sigmoidoscopy for symptom assessment.

RESULTS: A total 120 patients were randomized to the study groups. The main indication for sigmoidoscopy was investigation of rectal bleeding (n=80). There was no significant difference in bowel cleansing quality, measured by the endoscopist blinded to preparation, between P/MC, P/MC plus enema, and enema alone as measured by the modified Ottawa Bowel Preparation Scale (P=0.34) or the Aronchick Scale (P=0.13). Both oral P/MC regimens were associated with higher incidence of nausea, abdominal pain, bloating, and interrupted sleep than enema alone (P<0.05).

CONCLUSIONS: A single dose of oral P/MC administered the night before did not result in better colon cleansing for sigmoidoscopy when used alone or with an enema and was associated with more side effects (NCT 01554111).

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