It’s just the prep that’s awful!
That’s what many people say about colonoscopy, and it’s a big reason why they avoid screening.
Two studies reported during Digestive Disease Week 2010 looked at ways to make the prep easier for patients.
In one, doctors at Henry Ford Hospital in Detroit gave a drug usually prescribed for constipation or a placebo to patients along with a gallon of polyethylene glycol with electrolytes (PEG-EL) and told them to stop drinking the PEG solution when their bowel movements were clear.
A second trial in Europe compared 4 liters of PEG-EL to 2 liters of PEG-EL with ascorbic acid (MoviPrep®).
At Henry Ford Hospital, patients preparing for screening colonoscopy were randomized into two groups: one given a tablet of lubiprostone (Amitiza®) on the two days before their exam and a second group who got a placebo instead. Both groups were told to drink the PEG-EL solution only until bowel movements were clear. Normally patients are told to drink an eight ounce glass of liquid every 10 minutes until they finish the entire gallon.
Neither patients or their gastroenterologists knew who got which prep.
The quality of the prep was judged on the amount of stool and liquid left in the colon.
Although patients who took lubiprostone drank less PEG-EL solution, the quality of prep was actually judged to be better overall.
- The lubiprostone group drank an average of 2.6 liters of solution compared to 3.1 liters for those patients who got a placebo.
- Overall quality of prep, as measured by the Ottawa scale,was 3.1 for luprostone and 4.0 for placebo.
Chetan Pai, D.O., a Henry Ford Hospital gastroenterologist and lead author of the study said,
Most people say they don’t want to have a colonoscopy because they find the preparation intolerable. If physicians are able to offer a better way to prep, I think this will encourage more people to get the colonoscopies that may save their lives.
His team concluded,
Lubiprostone plus PEG-electrolytes led to improved bowel preparation quality and decreased consumption of PEG-electrolytes compared with PEG-electrolytes alone when used for colonoscopy bowel preparation.
SOURCE: Pai et al, Digestive Disease Week Abstract #S1052, Lubiprostone Plus Polyethylene Glycol Is Superior to Polyethylene Glycol for Outpatient Colonoscopy Preparation: a Randomized, Double-Blind, Placebo-Controlled Trial.
Doctors in Europe randomly assigned people who were preparing for colonoscopy to either 4 liters of Colopeg® (a PEG-EL solution) or 2 liters of MoviPrep®, a PEG solution with additional ascorbic acid.
- There was no statistical difference in bowel cleansing between the two preps: 94.1 percent in the MoviPrep group and 90 percent in the Colopeg group had excellent to fair cleansing.
- But patients preferred the taste of MoviPrep, and scored the entire colonoscopy procedure and MoviPrep itself higher.
- 80 percent of patients found MoviPrep easy to drink and 85 percent finished it.
- 87 percent said they would take it again, compared to 51 percent of those who prepped with Colopeg.
- Adverse events were lower in the MoviPrep group.
- There were no significant differences in polyp detection or number of colonoscopies that had to be stopped due to poor preparation.
The team led by Thierry Ponchon concluded,
2L MOVIPREP® provided 100% musosal visualisation in 94% of subjects and was at least as good as 4L Colopeg®. High patient acceptability and compliance, together with a good safety profile make the low volume MOVIPREP® solution an ideal preparation in routine practice.
SOURCE: Ponchon et al, Digestive Disease Week 2010 Abstract S1025, Efficacy, Safety and Acceptability of a 2l Polyethylene Glycol With Electrolytes and Ascorbate Components Solution Versus 4l Polyethylene Glycol and Electrolytes Solution for Bowel Cleansing Prior to Colonoscopy.