A Blinded, Randomized Comparison of a Novel, Low-Dose, Triple Regimen with Fleet Phospho-Soda: A Study of Colon Cleanliness, Speed and Success of Colonoscopy

Background and Study Aims: A clean colon is essential for an efficient examination. The aim of this study was to compare a novel low-dose, low volume triple regimen with Fleet Phospho-soda.

Methods: A blinded, experienced colonoscopist examined 132 consecutive patients randomly allocated to receive either a triple regimen consisting of senna syrup (sennoside B), Picolax (sodium picosulphate), and Klean Prep (polyethylene glycol 3350), or Fleet Phospho-soda (sodium dihydrogen phosphate and disodium phosphate dodecahydrate). The colonoscopist recorded cleanliness according to a scoring system (1 - very clean to 4 - solid stools), and time taken to reach the caecum.

Results: In the triple regimen group (n = 81), 73 % scored 1 or 2 compared with 57 % in the Fleet Phospho-soda group (n = 51, p = 0.037 Mann-Whitney U-test). Examination to caecum was achieved in 95 % of the triple regimen group and 89 % of the Fleet Phospho-soda group. Among those examined as far as the caecum, the time to reach the caecum was 11 minutes (range 5 - 50) in the triple regimen group compared with 16 minutes (range 5 - 65) in the Fleet Phospho-soda group (p = 0.08, Mann-Whitney U-test). Patient tolerability was not assessed in this study.

Conclusions: This novel triple regimen produces a cleaner colon than Fleet Phospho-soda, is associated with a trend towards a quicker and more efficient colonic examination, and is also 30 % cheaper per patient.

References

• 1 Davis G R, Santa Ana C A, Morawski S G, Fordtran J S. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion.  Gastroenterology. 1980;  78 991-995
• 2 Fordtran J S, Santa Ana C A, Cleveland M VB. A low-sodium solution for gastrointestinal lavage.  Gastroenterology. 1990;  98 11-16
• 3 Di Palma J A, Brady C E, Pierson W P. Colon cleansing acceptance by older patients.  Am J Gastroenterol. 1986;  81 652-655
• 4 Cohen S M, Wexner S D, Binderow S R, et al. A prospective randomised endoscopic-blinded trial comparing pre-colonoscopy bowel cleansing methods.  Dis Colon Rectum. 1994;  37 689-696
• 5 Yohioka K, Bates J, Morton D, Keighley M RB. Randomised trial of oral sodium posphate compared with oral sodium picosulphate in preparation of the colon for colonoscopy.  Gut. 1997;  40 (suppl. 1) 40
• 6 Vanner S J, MacDonald P H, Paterson W G, et al. A randomised, prospective trial comparing oral sodium phosphate with standard polyethylene glycol lavage solution (Golytely) in the preparation of patients for colonsocopy.  Am J Gastroenterol. 1990;  85 422-427
• 7 Kolts B E, Lyles W E, Achem S R, et al. Comparison of the effectiveness and patients tolerance of oral sodium phosphate, castor oil and standard electrolyte lavage for colonoscopy or sigmoidoscopy preparation.  Am J Gastroenterol. 1993;  88 1212-1223
• 8 Marshall J B, Pineda J J, Barthel K S, King P D. Prospective randomised trial comparing sodium phosphate (PS) solution (Fleet Phospho-soda) with PEG electrolyte lavage solution (“Colyte”) for the preparation of patients for colonoscopy.  Gastrointest Endosc. 1993;  39 631-634
• 9 Bigard M A, Gaucher P, Lassaille C. Fatal colonic explosion during colonoscopic polypectomy.  Gastroenterology. 1979;  77 1307-1310