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Randomized Clinical Trial Comparing Reduced-Volume Oral Picosulfate and a Prepackaged Low-Residue Diet With 4-Liter PEG Solution for Bowel Preparation

Kim, Yong Sok M.D.1; Hong, Chang Won M.D.1; Kim, Byung Chang M.D.1; Han, Kyung Su M.D.1; Park, Ji Won M.D.1; Seong Choi, Hyo M.D.1; Joo, Jungnam Ph.D.2; Sohn, Dae Kyung M.D., Ph.D.1

Diseases of the Colon & Rectum: April 2014 - Volume 57 - Issue 4 - p 522–528
doi: 10.1097/DCR.0000000000000066
Original Contributions: Endoscopy

BACKGROUND: Reduced-volume bowel preparation with a low-residue diet prior to colonoscopy would result in better patient compliance and sufficient bowel preparation.

OBJECTIVE: To compare the clinical efficacy of reduced-volume sodium picosulfate and a prepackaged low-residue diet with that of the standard bowel preparation using 4 L of PEG solution.

DESIGN: Prospective, single center, single blind, active control, randomized study (NCCCTS-12–619, KCT0000470).

SETTING: Ambulatory outpatient clinic at the National Cancer Center, Republic of Korea.

PATIENTS: A total of 194 subjects were randomly assigned for this study, 97 in each group. After exclusions, 94 subjects in the Picolight group and 90 in the PEG group completed the study and were analyzed.

INTERVENTIONS: Sodium picosulfate with a prepackaged low-residue, one-day diet or 4-L PEG for bowel preparation.

MAIN OUTCOME MEASURES: Success rate of the bowel preparation, tolerability, adverse events, cecal intubation time, polyp detection rate and adenoma detection rate.

RESULTS: The bowel preparation success rate was significantly higher (91.5% vs. 81.1%, p = 0.04) and the rates of adverse events, including abdominal distension, pain, nausea, vomiting and abdominal discomfort, were significantly lower in the picosulfate group than the PEG group. Cecal intubation times and the polyp and adenoma detection rates were similar in the 2 groups.

LIMITATIONS: Single center, limited population, all colonoscopies were performed in the morning.

CONCLUSIONS: Bowel preparation with low-volume oral picosulfate and a prepackaged low-residue diet enhances colon cleansing and is better tolerated than the standard bowel preparation.

1Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, South Korea

2Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, South Korea

Funding/Support: This study was supported by a grant from the National Cancer Center (NCC-1210170).

Financial Disclosure: The authors claim no conflicts of interest.

Podium presentation at the 46th Annual Korean Society of Coloproctology Meeting in Gyeongju, Republic of Korea, April 5–7, 2013

Y. S. Kim, C. W. Hong, and B. C. Kim contributed equally to this study.

Correspondence: Dae Kyung Sohn, M.D., Ph.D., Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 410–769, Republic of Korea. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons