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94
PICO-SALAX PLUS TWO DAY BISACODYL IS SUPERIOR TO PICO-SALAX ALONE OR ORAL SODIUM PHOSPHATE FOR COLON CLEANSING PRIOR TO COLONOSCOPY
L Hookey, S Vanner
Gastrointestinal Diseases research Unit, Queen's University, Kingston, Ontario
Aims: Despite years of research and effort, the ideal bowel preparation for colonoscopy has yet to be found, this despite increasing volumes of colonoscopies and further attention to adenoma detection rates and flat neoplasia. Pico-Salax is a new product to North America and is a small volume osmotically active agent- each sachet of contains: 10 mg of sodium picosulfate, a stimulant laxative and Magnesium Oxide 3.5g and Citric Acid 12.0g -an osmotic laxative. The typical dose is two sachets five hours apart the evening prior to colonoscopy. Although the market share of Pico-Salax has grown rapidly, anecdotal evidence suggested there were concerns with efficacy. We hypothesized that the addition of bisacodyl to this regimen would enhance bowel cleansing. This study examined whether Pico-salax or Pico-Salax plus bisacodyl tablets for two nights before affords superior efficacy, patient tolerability and safety compared to 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 5PM in the two previous 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 L of Gatorade or other clear fluids the night before the colonoscopy.
Results: Global scoring of cleansing efficacy using the Ottawa Bowel Preparation Scale did not reveal differences among groups, but Pico-Salax plus bisacodyl was superior in cleansing in the right colon compared to the other regimens (p = 0.003), providing almost 50% improvement over oral sodium phosphate. Patient tolerability 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 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 to Pico-Salax alone or oral sodium phosphate, but does not compromise the much greater patient tolerability or safety profile of Pico-Salax alone.
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