Diseases of the Colon & Rectum

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Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e3182707d27
Original Contribution: Endoscopy

Keeping the Cecum Clean: A Randomized, Prospective, Placebo-Controlled Trial of Loperamide as Part of Preparation for Colonoscopy

Church, James M.B.Ch.B.; Bast, Jane R.N.; Elayi, Elodie M.S.; Xhaja, Xhileta M.D.

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BACKGROUND: Coating of the cecum with sticky bile causes a problem with inspection of the mucosa during colonoscopy.

PURPOSE: This study aimed to see whether 4 mg of loperamide taken after colonoscopy preparation would delay the passage of bile and improve the quality of cecal preparation.

PATIENTS: Patients undergoing office colonoscopy were included. Patients with incomplete colonoscopies or right colectomy were excluded.

STUDY DESIGN: This study was a prospective, randomized, double-blinded, and placebo-controlled trial.

INTERVENTION: Either 2 placebo capsules or 2 loperamide capsules were taken after gut lavage, as soon as the passage of liquid stool ceased. Cecal photographs were scored in a blinded fashion.

MAIN OUTCOME MEASURES: The primary outcomes measured were the quality of cecal preparation on a scale of 1 to 5 and overall preparation on a scale of 1 to 4.

RESULTS: Ninety-eight patients took loperamide (50 men, 48 women) and 102 took placebo (57 men, 45 women). Mean ages of the loperamide group were: men, 61.9 ± 11.9 years, and women, 61.8 ± 10.0 years; and mean ages of the placebo group were: men, 62.5 ± 12.1 years, and women, 58.6 ± 9.8 years. Over 90% of patients used a polyethylene glycol-based preparation. Thirteen of 102 (12.7%) placebo cases had a dirty or coated cecum (score 4 or 5). In the loperamide group, this number was 2 of 98 (2.0%; p = 0.0041). Nineteen placebo cases (18.6%) had an overall fair/poor preparation in comparison with 9 of the loperamide group (9.2%; p = 0.0543). Days to first bowel movement were 2.4 ± 1.1 for loperamide and 2.5 ± 1.7 for placebo (p = 0.7224). Fifty-eight percent of loperamide patients had polyps, and 74% of these patients had multiple polyps; 67% of placebo patients had polyps, but only 54% of these patients had multiple polyps (vs loperamide, p = 0.0183).

CONCLUSION: Judicious use of loperamide can significantly improve the quality of cecal preparation and may increase polyp yield.

© The ASCRS 2013


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