Randomized Controlled Trial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2015; 21(6): 1938-1944
Published online Feb 14, 2015. doi: 10.3748/wjg.v21.i6.1938
Split-dose menthol-enhanced PEG vs PEG-ascorbic acid for colonoscopy preparation
Ala I Sharara, Ali H Harb, Fayez S Sarkis, Jean M Chalhoub, Rami Badreddine, Fadi H Mourad, Mahmoud Othman, Omar Masri
Ala I Sharara, Ali H Harb, Fayez S Sarkis, Jean M Chalhoub, Rami Badreddine, Fadi H Mourad, Mahmoud Othman, Omar Masri, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, 11-0236/16-B Beirut, Lebanon
Author contributions: Sharara AI designed the research study; Sharara AI and Harb AH drafted the manuscript; Sharara AI, Harb AH and Sarkis FS performed research; Sharara AI, Harb AH, Sarkis FS, Masri O, Othman M, Badreddine R and Mourad FH recruited patients, interpreted the data and critically reviewed the manuscript; Harb AH performed the statistical data analysis; Harb AH and Sarkis FS performed the regulatory administration tasks; Chalhoub JM did the final editing of the manuscript, executed the figures, and managed references; all authors approved the submitted version of the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ala I Sharara, MD, FACG, AGAF. Professor, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, 11-0236/16-B Beirut, Lebanon. as08@aub.edu.lb
Received: August 6, 2014
Peer-review started: August 8, 2014
First decision: August 27, 2014
Revised: September 30, 2014
Accepted: November 18, 2014
Article in press: November 19, 2014
Published online: February 14, 2015
Processing time: 188 Days and 19.9 Hours
Abstract

AIM: To compare the efficacy and palatability of 4 L polyethylene glycol electrolyte (PEG) plus sugar-free menthol candy (PEG + M) vs reduced-volume 2 L ascorbic acid-supplemented PEG (AscPEG).

METHODS: In a randomized controlled trial setting, ambulatory patients scheduled for elective colonoscopy were prospectively enrolled. Patients were randomized to receive either PEG + M or AscPEG, both split-dosed with minimal dietary restriction. Palatability was assessed on a linear scale of 1 to 5 (1 = disgusting; 5 = tasty). Quality of preparation was scored by assignment-blinded endoscopists using the modified Aronchick and Ottawa scales. The main outcomes were the palatability and efficacy of the preparation. Secondary outcomes included patient willingness to retake the same preparation again in the future and completion of the prescribed preparation.

RESULTS: Overall, 200 patients were enrolled (100 patients per arm). PEG + M was more palatable than AscPEG (76% vs 62%, P = 0.03). Completing the preparation was not different between study groups (91% PEG + M vs 86% AscPEG, P = 0.38) but more patients were willing to retake PEG + M (54% vs 40% respectively, P = 0.047). There was no significant difference between PEG + M vs AscPEG in adequate cleansing on both the modified Aronchick (82% vs 77%, P = 0.31) and the Ottawa scale (85% vs 74%, P = 0.054). However, PEG + M was superior in the left colon on the Ottawa subsegmental score (score 0-2: 94% for PEG + M vs 81% for AscPEG, P = 0.005) and received significantly more excellent ratings than AscPEG on the modified Aronchick scale (61% vs 43%, P = 0.009). Both preparations performed less well in afternoon vs morning examinations (inadequate: 29% vs 15.2%, P = 0.02).

CONCLUSION: 4 L PEG plus menthol has better palatability and acceptability than 2 L ascorbic acid- PEG and is associated with a higher rate of excellent preparations; Clinicaltrial.gov identifier: NCT01788709.

Keywords: Colonoscopy; Bowel preparation; Efficacy; Tolerability; Menthol

Core tip: Colon preparations are generally poorly tolerated. As a result, suboptimal bowel preparation can occur in as many as 25%-40% of cases. Volume and palatability of the purgative are important determinants of tolerability and adherence and, consequently of efficacy. In this randomized controlled trial, we investigate the efficacy and palatability of two colonic preparations (4 L PEG + menthol candy vs 2 L ascorbic acid supplemented -PEG) given as split-dose and with minimal dietary restrictions. Both preparations were similarly effective at achieving adequate colon preparation but 4 L PEG + M had superior palatability and tolerability and was associated with more excellent ratings.