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Pico-Salax Plus Two-Day Bisacodyl Is Superior to Pico-Salax Alone or Oral Sodium Phosphate for Colon Cleansing Before Colonoscopy

2009; Lippincott Williams & Wilkins; Volume: 104; Issue: 3 Linguagem: Inglês

10.14309/00000434-200903000-00031

1572-0241

Lawrence Hookey, Stephen Vanner,

Gastric Cancer Management and Outcomes

OBJECTIVES: This study examined whether Pico-Salax alone or Pico-Salax plus bisacodyl tablets for two nights before colonoscopy afford superior efficacy, patient tolerance, and safety compared with oral sodium phosphate. METHODS: Patients undergoing outpatient colonoscopy were randomized to receive either Pico-Salax at 5 and 10 PM the night before colonoscopy plus bisacodyl 10 mg at 5 PM in the two earlier evenings (n= 105), Pico-Salax alone at 5 and 10 PM the night before colonoscopy (n= 109), or oral sodium phosphate at 5 and 10 PM the night (n= 101) before colonoscopy. All groups were encouraged to drink 3-4 I of Gatorade or other clear fluids the night before the colonoscopy. RESULTS: Global scoring of cleansing efficacy using the Ottawa scale did not reveal differences among groups, but Pico-Salax plus bisacodyl was superior in cleansing the right colon compared with the other regimens (P=0.003), providing almost 50% improvement over oral sodium phosphate. Patient tolerance of Pico-Salax plus bisacodyl did not differ from Pico-Salax alone but was much better than oral sodium phosphate (P<0.0001). Hemodynamic and biochemical monitoring of patients on Pico-Salax plus bisacodyl suggests this regimen has a very strong safety profile. It does not differ from Pico-Salax alone, which lacks the hyperphosphatemia and hypocalcemia associated with oral sodium phosphate. CONCLUSIONS: Together, these data suggest that Pico-Salax plus bisacodyl provides enhanced colon cleansing in the right colon compared with Pico-Salax alone or oral sodium phosphate, but this finding does not compromise the much greater tolerability or the safety profile of Pico-Salax alone.