Clinical Endoscopy

Bowel preparation for small bowel capsule endoscopy: standard regimen with 2 L polyethylene glycol versus 1 L polyethylene glycol plus ascorbate: Riccardo Caccia, Alessandro Rimondi, Luca Elli, Matilde Topa, Flaminia Cavallaro, Carmine Gentile, Lucia Scaramella, Nicoletta Nandi, Reena Sidhu, Pinhas Eidler, Maurizio Vecchi, Gian Eugenio Tontini; Clin Endosc 2025;58(2):285-290. Published online January 2, 2025; DOI: https://doi.org/10.5946/ce.2024.097

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Optimization of bowel preparation for small bowel capsule endoscopy (SBCE) is debated. Guidelines recommend 2 L of iso-osmolar polyethylene glycol (PEG) to improve SBCE visibility. We compared the efficacy of the standard 2 L PEG solution with a 1 L PEG plus ascorbate (PEG-ASC) preparation, which has already been established for large-bowel preparation.
Methods
Between October 2020 and February 2022, patients undergoing SBCE were assigned to receive 2 L PEG or 1 L PEG-ASC bowel preparation on an even- or odd-day basis. Bowel cleanliness was evaluated using the small bowel mucosal visibility scoring system (SBMVSS).
Results
Following propensity score matching using a random forest method, two comparable populations of patients treated with 2 L PEG (n=74, male 41%, 53±17 years) and 1 L PEG-ASC (n=74, male 42%, 55±21 years) were obtained from the original cohort of 221 consecutive SBCE patients. Our results showed a trend towards more frequent adequate mucosal visibility with 1 L PEG-ASC compared to 2 L PEG (small bowel mucosal visibility ≥2 in all three small bowel tertiles, p=0.07), as per the SBMVSS score. No significant differences were observed in the diagnostic yield (p=1.00), visibility score=9 (p=0.85), SBCE completeness (p=0.33), or adequate mucosal visibility in each tertile (p=0.61, p=0.74, and p=0.70 for the first, second, and third tertiles, respectively).
Conclusions
Our study suggests the non-inferiority of the 1 L PEG-ASC solution over the standard 2 L PEG for SBCE preparation.

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Novel regimen for colonoscopy bowel preparation with oral lactulose: a prospective comparative study: Josué Aliaga Ramos, Danilo Carvalho, Vitor N. Arantes; Clin Endosc 2024;57(6):775-782. Published online October 22, 2024; DOI: https://doi.org/10.5946/ce.2024.056

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Polyethylene glycol (PEG) is considered the gold standard regimen for bowel preparation; however, due to the necessity of a large volume, patient tolerance is impaired. Therefore, lactulose is a novel alternative for colonoscopy preparation. This study aimed to investigate the efficacy and safety of lactulose-based bowel preparations in comparison with PEG for colonoscopy.
Methods
This is a prospective, non-blinded, comparative study. Outpatients were randomly divided into two groups: group 1 (111 patients), PEG; and group 2 (111 patients), lactulose. The following clinical outcomes were assessed in each group: degree of bowel clearance using the Boston bowel preparation score, colorectal polyp detection rate, adenoma detection rate, tolerability, and side effects.
Results
The rate of inadequate bowel preparation was 8.1% and 1.8% for the PEG and lactulose groups, respectively (p=0.030). The Boston bowel preparation score for the entire colon was 7.34±1.17 and 8.36±1.09 for the PEG and lactulose groups, respectively (p<0.001). The satisfactory overall experience rates were 27.9% and 62.2% for the PEG and lactulose groups, respectively (p<0.001).
Conclusions
The novel bowel preparation with oral lactulose was superior to that with PEG in terms of colon cleansing, adenoma detection rate, tolerance, and patient experience.

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Bowel Preparation Agents: Balancing Efficacy for Colon Cleansing and Safety for Stomach Safety
Gwang Ha Kim
The Korean Journal of Gastroenterology.2024; 84(6): 293. CrossRef

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Comparison of Oral Sulfate Solution and Polyethylene Glycol Plus Ascorbic Acid on the Efficacy of Bowel Preparation: Ji Hyung Nam, Seok Bo Hong, Yun Jeong Lim, Seongju Lee, Hyoun Woo Kang, Jae Hak Kim, Jin Ho Lee; Clin Endosc 2020;53(5):568-574. Published online April 24, 2020; DOI: https://doi.org/10.5946/ce.2019.209

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Background
/Aims: The quality of bowel preparation is one of the quality indicators for colonoscopy. The aim of this study was to compare the efficacy of oral sulfate solution (OSS) and polyethylene glycol plus ascorbic acid (PEG-AA) for bowel preparation.
Methods
The study involved 167 patients who underwent diagnostic colonoscopies. Inadequate bowel preparation was defined as any score of ≤1 in each colon section based on the Boston Bowel Preparation Scale. Multivariate logistic regression was used to compare the efficacy of OSS and PEG-AA. Subgroup analyses were performed based on patient characteristics.
Results
Overall, 106 (63.5%) patients received OSS, and 61 (36.5%) patients received PEG-AA. The rate of inadequate bowel preparation was 12.3% in patients receiving OSS and 32.8% in patients receiving PEG-AA (p=0.001). OSS (odds ratio [OR] = 0.26; p=0.003) and morning examination (OR=0.11; p=0.038) were significantly associated with efficient bowel preparation. The efficacy of OSS compared with PEG-AA was only significant in patients ≥50 years of age vs. <50 years of age (OR=0.13; p=0.001 vs. OR=0.96; p=0.959) and female vs. male patients (OR=0.06; p=0.002 vs. OR=0.58; p=0.339).
Conclusions
OSS was significantly more efficient for bowel preparation than PEG-AA, especially in patients ≥50 years of age and female patients. Morning examination led to a good quality of bowel preparation, irrespective of the preparation regimen.

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Efficacy of Oral Sulfate Tablet and 2 L-Polyethylene Glycol With Ascorbic Acid for Bowel Preparation: A Prospective Randomized KASID Multicenter Trial
Yunho Jung, Hyun Gun Kim, Dong-Hoon Yang, Hyoun Woo Kang, Jae Jun Park, Dong Hoon Baek, Jaeyoung Chun, Tae-Geun Gweon, Hyeon Jeong Goong, Min Seob Kwak, Hyun Jung Lee, Soo-Kyung Park, Jong Hoon Lee
Journal of Korean Medical Science.2024;[Epub] CrossRef
Observation of the application effect of low-volume polyethylene glycol electrolyte lavage solution (PEG-ELS) combined with ascorbic acid tablets in bowel preparation for colonoscopy in hospitalized patients
Le-Can Wu, En-Dian Zheng, Hao-Yue Sun, Xi-Zhou Lin, Ju-Yi Pan, Xiao-Xiao Lin
Frontiers in Oncology.2023;[Epub] CrossRef
Comparison of the efficacy and safety of an oral sulfate solution and 3-L polyethylene glycol on bowel preparation before colonoscopy: a phase III multicenter randomized controlled trial
Peng Pan, Shengbing Zhao, Shuling Wang, Yihang Song, Lun Gu, Youxiang Chen, Jiangrong Zhao, Lungen Lu, Xiuling Li, Hongzhi Xu, Gaifang Liu, Yanqing Li, Le Xu, Jiangbin Wang, Zhaoshen Li, Yu Bai
Gastrointestinal Endoscopy.2023; 98(6): 977. CrossRef
Randomized trial of oral sulfate solution versus polyethylene glycol–ascorbic acid for bowel cleansing in elderly people
Seung‐Joo Nam, Sung Chul Park, Sung Joon Lee, Sang Hoon Lee, Ji Hyun Kim, Chang Seok Bang, Hyun Il Seo
Journal of Gastroenterology and Hepatology.2022; 37(2): 319. CrossRef
Comparison of 2 L Polyethylene Glycol Plus Ascorbic Acid and 4 L Polyethylene Glycol in Elderly Patients Aged 60–79: A Prospective Randomized Study
Sung Hoon Jung, Chul-Hyun Lim, Tae-Geun Gweon, Jinsu Kim, Jung Hwan Oh, Kyu-Tae Yoon, Jee Young An, Jeong‑Seon Ji, Hwang Choi
Digestive Diseases and Sciences.2022; 67(10): 4841. CrossRef
Oral sulfate solution benefits polyp and adenoma detection during colonoscopy: Meta‐analysis of randomized controlled trials
Cheng Chen, Mengyang Shi, Zhongli Liao, Weiqing Chen, Yongzhong Wu, Xu Tian
Digestive Endoscopy.2022; 34(6): 1121. CrossRef
Efficacy, safety and tolerability of oral sulphate tablet for bowel preparation in patients with inflammatory bowel disease: A multicentre randomized controlled study
Kyeong Ok Kim, Eun Young Kim, Yoo Jin Lee, Hyun Seok Lee, Eun Soo Kim, Yun Jin Chung, Byung Ik Jang, Sung Kook Kim, Chang Heon Yang
Journal of Crohn's and Colitis.2022; 16(11): 1706. CrossRef
How to Choose the Optimal Bowel Preparation Regimen for Colonoscopy
Ji Eun Na, Eun Ran Kim
The Ewha Medical Journal.2021; 44(4): 122. CrossRef
Oral Sulfate Solution is as Effective as 2 L Polyethylene Glycol Plus Ascorbic Acid
Sung Hyun Shin, Kwang An Kwon
Clinical Endoscopy.2020; 53(5): 503. CrossRef

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The Efficacy of 4 Liters of Clear Liquids for Small Bowel Preparation Prior to Video Capsule Endoscopy: Nicholas Placone, Runalia Bahar, Surinder Mann; Clin Endosc 2020;53(6):713-718. Published online March 31, 2020; DOI: https://doi.org/10.5946/ce.2019.213

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Background
/Aims: Optimal small bowel (SB) preparation for video capsule endoscopy (VCE) is controversial. Our study aimed to support the use of a specified volume of 4 liters of clear liquids for bowel preparation for VCE.
Methods
A retrospective review of 284 patients who underwent SB preparation with 2 liters of polyethylene glycol (PEG) and 284 patients who had 4 liters of clear liquid preparation. We analyzed image quality, endoscopic findings, completion rate, and transit times.
Results
The 4-liter clear liquid group had significantly higher mean image quality scores when compared to the PEG group (2.908±0.77 to 2.669±0.64, p<0.0001), as well as more studies with adequate preparation (72% to 64%, p=0.0214). Although the PEG group had more endoscopic findings on VCE (40% to 23%, p<0.0001), there was a significant difference in the indications for the procedure between the groups. There was no difference in the capsule completion rate or SB transit time.
Conclusions
Our data demonstrate significantly higher mean image quality scores when using a specified volume of 4 liters of clear liquid compared to 2 liters of PEG. This study supports the growing evidence of the effectiveness of a 4-liter clear liquid SB preparation as opposed to PEG for VCE.

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Small bowel cleansing for capsule endoscopy, systematic review and meta- analysis: Timing is the real issue
Clelia Marmo, Maria Elena Riccioni, Marco Pennazio, Giulio Antonelli, Cristiano Spada, Guido Costamagna
Digestive and Liver Disease.2023; 55(4): 454. CrossRef
Disease surveillance evaluation of primary small-bowel follicular lymphoma using capsule endoscopy images based on a deep convolutional neural network (with video)
Akihiko Sumioka, Akiyoshi Tsuboi, Shiro Oka, Yusuke Kato, Yuka Matsubara, Issei Hirata, Hidehiko Takigawa, Ryo Yuge, Fumio Shimamoto, Tomohiro Tada, Shinji Tanaka
Gastrointestinal Endoscopy.2023; 98(6): 968. CrossRef
A colorectal cancer missed by colon capsule endoscopy: a case report
C. MacLeod, R. Oliphant, J. G. Docherty, A. J. M. Watson
BMC Gastroenterology.2022;[Epub] CrossRef
Value of the diving method for capsule endoscopy in the examination of small-intestinal disease: a prospective randomized controlled trial
Xianhui Zeng, Liansong Ye, Jianrong Liu, Xianglei Yuan, Shan Jiang, Minghui Huang, Xiujiang Huang, Chengwei Tang, Bing Hu
Gastrointestinal Endoscopy.2021; 94(4): 795. CrossRef
Bowel Preparation for Small Bowel Capsule Endoscopy: Is There Still a Role for Polyethylene Glycol?
Paul Collins, Neil Haslam, Anthony Morris, Thomas Skouras, Ashley Bond
Journal of Digestive Endoscopy.2020; 11(03): 215. CrossRef
Capsule endoscopy – Recent developments and future directions.
Stefania Zammit Chetcuti, Reena Sidhu
Expert Review of Gastroenterology & Hepatology.2020;[Epub] CrossRef
Ideal Method for Small Bowel Preparation before Video Capsule Endoscopy
Jun Lee, Shai Friedland
Clinical Endoscopy.2020; 53(6): 631. CrossRef

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7 Crossref

Optimal and Safe Bowel Preparation for Colonoscopy: Won Moon; Clin Endosc 2013;46(3):219-223. Published online May 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.3.219

Abstract PDF PubReader ePub

Effective colonoscopy requires an adequate level of cleansing as a basic component. This review will describe a compact review about general considerations in bowel preparation for colonoscopy and specific considerations for various patients. A low-fiber diet instead of a regular diet on the day before colonoscopy is an independent predictor of adequate bowel preparation. Improved bowel cleansing does not result from the routine use of enemas or prokinetics in addition to oral bowel preparation. For morning colonoscopy, a split method of 4 L polyethylene glycol on the day before and the day of colonoscopy is recommended, while patients scheduled for afternoon colonoscopy typically receive a full method of 4 L polyethylene glycol on the day of the procedure. Valid alternatives are 2 L polyethylene glycol plus ascorbic acid or 2 L sodium picosulphate plus magnesium citrate. Although there are no statistically significant differences between polyethylene glycol and oral sodium phosphate for colon cleansing, polyethylene glycol-based bowel preparation is advisable in most situations because of safety concerns.

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Gastrointestinal pharmacoradiology, an updated review of medications and gastrointestinal contrasts in abdominal imaging
Nour Nakrour, J. E. Neibling, Avani Pathak, Alberto Carbo
Abdominal Radiology.2024; 50(2): 1038. CrossRef
Care of the hospitalised patient receiving peritoneal dialysis: Your questions answered
Rehab B Albakr, Joanne M Bargman
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis.2023; 43(1): 5. CrossRef
Comparison of 2 L Polyethylene Glycol Plus Ascorbic Acid and 4 L Polyethylene Glycol in Elderly Patients Aged 60–79: A Prospective Randomized Study
Sung Hoon Jung, Chul-Hyun Lim, Tae-Geun Gweon, Jinsu Kim, Jung Hwan Oh, Kyu-Tae Yoon, Jee Young An, Jeong‑Seon Ji, Hwang Choi
Digestive Diseases and Sciences.2022; 67(10): 4841. CrossRef
Colonoscopy: an evidence-based approach
Lucy Kelly
Nursing Standard.2022; 37(4): 77. CrossRef
Same-day single-dose vs large-volume split-dose regimens of polyethylene glycol for bowel preparation: A systematic review and meta-analysis
Hui Pan, Xiao-Ling Zheng, Chao-Ying Fang, Lan-Zai Liu, Jian-Su Chen, Chao Wang, Yu-Dai Chen, Jian-Min Huang, Yu-Shen Zhou, Li-Ping He
World Journal of Clinical Cases.2022; 10(22): 7844. CrossRef
A case of severe acute hyponatremia after colonoscopy with polyethylene glycol plus ascorbic acid bowel preparation
Aki Yamada, Toshihiro Kanda, Toshiro Sugimoto
CEN Case Reports.2022; 12(2): 254. CrossRef
Oral Probiotics Alleviate Intestinal Dysbacteriosis for People Receiving Bowel Preparation
Xiaorong Deng, Huakai Tian, Rong Yang, Yiwen Han, Kehong Wei, Cihua Zheng, Zhaoxia Liu, Tingtao Chen
Frontiers in Medicine.2020;[Epub] CrossRef
Efficacy and Patient Tolerability Profiles of Probiotic Solution with Bisacodyl Versus Conventional Cleansing Solution for Bowel Preparation: A Prospective, Randomized, Controlled Trial
Youn I Choi, Jong-Joon Lee, Jun-Won Chung, Kyoung Oh Kim, Yoon Jae Kim, Jung Ho Kim, Dong Kyun Park, Kwang An Kwon
Journal of Clinical Medicine.2020; 9(10): 3286. CrossRef
Low-Volume Polyethylene Glycol Improved Patient Attendance in Bowel Preparation Before Colonoscopy: A Meta-Analysis With Trial Sequential Analysis
Li-Juan Yi, Xu Tian, Bing Shi, Hui Chen, Xiao-Ling Liu, Yuan-Ping Pi, Wei-Qing Chen
Frontiers in Medicine.2019;[Epub] CrossRef
Comparison of Bowel Cleansing Efficacy, Safety, Bowel Movement Kinetics, and Patient Tolerability of Same-Day and Split-Dose Bowel Preparation Using 4 L of Polyethylene Glycol: A Prospective Randomized Study
Myeongsook Seo, Tae-Geun Gweon, Cheal Wung Huh, Jeong Seon Ji, Hwang Choi
Diseases of the Colon & Rectum.2019; 62(12): 1518. CrossRef
Comparative efficacy of low volume versus traditional standard volume PEG on bowel preparation before colonoscopy
Li-Juan Yi, Xu Tian, Yuan-Ping Pi, Ling Feng, Hui Chen, Xiao-Ling Liu, Wei-Qing Chen
Medicine.2018; 97(17): e0599. CrossRef
Magnesium and Drugs Commonly Used in Chronic Kidney Disease
Jeffrey H. William, Katelyn Richards, John Danziger
Advances in Chronic Kidney Disease.2018; 25(3): 267. CrossRef
Severe symptomatic hyponatremia associated with the use of polyethylene glycol-based bowel preparation
Navira Samad, Ian Fraser
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The safety and effectiveness of 2-liter polyethylene glycol plus ascorbic acid in patients with liver cirrhosis
Jae Min Lee, Jae Hyung Lee, Eun Sun Kim, Jung Min Lee, In Kyung Yoo, Seung Han Kim, Hyuk Soon Choi, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Soon Ho Um, Chang Duck Kim
Medicine.2017; 96(51): e9011. CrossRef
Sodium phosphate versus polyethylene glycol for colonoscopy bowel preparation: an updated meta-analysis of randomized controlled trials
Ji Cheng, Kaixiong Tao, Xiaoming Shuai, Jinbo Gao
Surgical Endoscopy.2016; 30(9): 4033. CrossRef
Increased Risk of Adverse Renal Outcome Following Polyethylene Glycol Bowel Preparation Compared to Sodium Picosulfate
Aiden R. Liu, Amit X. Garg, Kuan Liu, Salimah Z. Shariff, Arsh K. Jain, Matthew A. Weir
The Journal of Clinical Pharmacology.2016; 56(8): 983. CrossRef
Soins péri-opératoires en chirurgie colorectale. En pratique, que faire?
C. Hobeika, J. H. Lefevre
Côlon & Rectum.2015; 9(2): 81. CrossRef
Renal risk associated with sodium phosphate medication: safe in healthy individuals, potentially dangerous in others
Iva Hoffmanová, Pavel Kraml, Michal Anděl
Expert Opinion on Drug Safety.2015; 14(7): 1097. CrossRef
Miralax With Gatorade for Bowel Preparation: A Meta-Analysis of Randomized Controlled Trials
Sameer Siddique, Kristi T Lopez, Alisha M Hinds, Dina S Ahmad, Douglas L Nguyen, Michelle L Matteson-Kome, Srinivas R Puli, Matthew L Bechtold
American Journal of Gastroenterology.2014; 109(10): 1566. CrossRef
Comparison of the Efficacy and Safety of Sodium Phosphate Tablets and Polyethylene Glycol Solution for Bowel Cleansing in Healthy Korean Adults
Seung-Hwa Lee, Duck-Joo Lee, Kwang-Min Kim, Sang-Wook Seo, Joon-Koo Kang, Eun-Hye Lee, Dong-Ryul Lee
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A Prospective Comparison of Sulfate Free Polyethylene Glycol versus Sodium Phosphate Solution for Precolonoscopic Bowel Preparation: Jin Gook Huh, M.D., You Sun Kim, M.D., Jong Hyeok Park, M.D., Kyung Sun Ok, M.D., Won Cheol Jang, M.D., Tae Yeob Jeong, M.D., Soo Hyung Ryu, M.D., Jung Hwan Lee, M.D. and Jeong Seop Moon, M.D.; Korean J Gastrointest Endosc 2009;39(5):265-270. Published online November 30, 2009

Abstract PDF: Background
/Aims: Polyethylene glycol (PEG) solution is commonly used for precolonoscopic preparation because of its safety and effectiveness. Sulfate free PEG (SF-PEG) solution was developed to reduce the salty taste by removing the sodium sulfate. The aim of this study was to compare the efficacy and patient compliance of SF-PEG and sodium phosphate (NaP) solutions for preparing the bowel before colonoscopy.
Methods
From February through April in 2007, 534 patients who underwent colonoscopy were prospectively enrolled. The efficacy of bowel cleansing was assessed by a doctor's questionnaire and the patient's compliance was assessed by a patient's questionnaire.
Results
There was no significant difference between the groups for the "stools and fluids" assessment of bowel cleansing (2.07 vs. 2.14, respectively, p=0.149). However, SF-PEG was more effective on the "air bubbles" assessment (1.34 vs. 1.71, respectively, p＜0.001) and the overall assessment (0.72 vs. 0.91, respectively, p=0.010) than NaP. The patients preferred SF-PEG rather than NaP for "Taste" (1.34 vs. 2.25, respectively, p=0.148). However, the patients significantly preferred NaP rather than SF-PEG for "Quantity" (2.46 vs. 1.18, respectively, p＜0.001).
Conclusions
The SF-PEG solution showed more effectiveness for bowel cleansing as compared to the NaP solution. SF-PEG tastes better than NaP, but patients are still required to consume 4 liters for the standard preparing regimen. (Korean J Gastrointest Endosc 2009;39:265-270)

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Acute Hyponatremic Encephalopathy after Ingestion of Polyethylene Glycol Solution before Colonoscopy: Chae Heo, M.D., Hyoung Chul Oh, M.D., Jeong Wook Kim, M.D. and Jae Gyu Kim, M.D.; Korean J Gastrointest Endosc 2009;39(3):169-171. Published online September 30, 2009

Abstract PDF: Preparation for colonoscopy involves a thorough cleansing of the large bowel. Cleansing is performed using several methods, including ingestion of 4 liters of polyethylene glycol solution. However, these methods can induce hyponatremia by various mechanisms. Severe or rapidly progressing hyponatremia can result in the swelling of the brain, and the symptoms of hyponatremia are mainly neurological. Recently, we encountered a 41-year-old woman who developed acute hyponatremia with encephalopathy after undergoing bowel preparation for colonoscopy. She presented with general weakness, nausea, headache, agitation, delusions, and slurred speech one day after the ingestion of polyethylene glycol solution. Her serum sodium level was very low (110 to 115 mEq/L). Her symptoms pertaining to hyponatremia continued to persist for more than 2 days despite continuous intravenous administration of hypertonic saline for the correction of hyponatremia. (Korean J Gastrointest Endosc 2009;39:169-171)

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A Prospective Randomized Trial Comparing Preference of Sulfate Free Polyethylene Glycol with Standard Polyethylene Glycol: Jun Seok Lee, M.D., Young Sook Park, M.D., Nam In Kim, M.D., Yun Ju Jo, M.D., Seong Hwan Kim, M.D., Moon Hee Song, M.D. and Dae Won Jun, M.D.; Korean J Gastrointest Endosc 2009;38(5):260-265. Published online May 30, 2009

Abstract PDF: Background
/Aims: The standard polyethylene glycol (PEG) solution for colonic cleansing has a salty taste and a large volume of it is required, which can cause failure for the patient to ingest the required dosage. This has been a limitation for its usage. Sulfate free PEG (SF-PEG) has a less salty taste due to removal of the sodium sulfate, but the published studies in western countries about the preference and the degree of patient's satisfaction with these two solutions has shown conflicting results. The object of this study was to compare SF-PEG with PEG solution in regard to preference, the degree of patient's satisfaction and the adverse effects in Korean patients. We also attempted to determine whether these factors were associated with preference.
Methods
Ninety-four patients scheduled for colonoscopy were given one liter of both solutions (SF-PEG and PEG) and then the patients were allowed to select either of the two solutions for the further two liters intake under informed consent. Before colonoscopy, the preferred solution, the degree of patient's satisfaction, the adverse effects and other information were recorded by questionnaire.
Results
Fifty-nine patients among the 94 patients (63%) preferred the SF-PEG solution (p＜0.05). Especially, the young patients under the age of 35 preferred the SF-PEG solution (83% vs 58%; p=0.045), and patients who had already experienced colonoscopy with PEG solution tended to prefer the SF-PEG (54% vs 78%; p=0.054).
Conclusions
Korean patients preferred the SF-PEG over PEG, and especially young aged patients and the patients who had already taken the PEG solution. Similar results were obtained for both solutions concerning the adverse effects, cleansing quality and compliance, and the degree of satisfaction was not much improved, which was probably due to the same large volume of fluid that is required for colon cleaning. (Korean J Gastrointest Endosc 2009;38:260-265)

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Hyponatremic Encephalopathy Following a Sulfate Free Polyethylene Glycol-based Bowel Preparation for Colonoscopy: Kyung Sun Ok, M.D., You Sun Kim, M.D., Won Cheol Jang, M.D., Tae Yeob Jeong, M.D., Jin Gook Huh, M.D., Soo Hyung Ryu, M.D., Jung Hwan Lee, M.D. and Jeong Seop Moon, M.D.; Korean J Gastrointest Endosc 2008;37(4):303-307. Published online October 30, 2008

Abstract PDF: Hyponatremia associated with the use of both a sodium phosphate (NaP) and polyethylene glycol (PEG) solution for colonoscopy preparation has been reported in patients with impaired renal handling of water. A PEG solution is believed to affect serum electrolytes less than NaP, but the use of a PEG solution can lead to nausea, vomiting, intestinal hyperactivity and dehydration, often resulting in a raised plasma antidiuretic hormone (ADH) concentration. Non-osmolar stimuli such as pain, stress, nausea, and vomiting can stimulate ADH release. We report a case of severe hyponatremic encephalopathy after sulfate-free PEG ingestion for a colonoscopy in a healthy middle-aged woman. We think that physicians should be familiar with the medical history and current medication schedule of patients prior to bowel preparation. The levels of serum electrolytes should be checked in patients with impaired ability to excrete free water and any mental aberrations before undertaking colonoscopy procedures. (Korean J Gastrointest Endosc 2008;37:303-307)

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A Prospective Trial Comparing 4 L-Polyethylene Glycol with 2 L-Polyethylene Glycol Plus Bisacodyl Tablets for Colon Preparation: Min-Jung Kang, M.D., Sung-Ae Jung, M.D., Ji Min Jung, M.D., Hyun Joo Song, M.D., Seong-Eun Kim, M.D., Hye-Kyung Jung, M.D., Ki-Nam Shim, M.D., Kwon Yoo, M.D. and Il-Hwan Moon, M.D.; Korean J Gastrointest Endosc 2008;37(3):167-173. Published online September 30, 2008

Abstract PDF: Background
/Aims: The aim of the study was to prospectively compare low-volume PEG plus 20 mg bisacodyl with the standard 4 L PEG with regards to the adequacy of bowel preparation, patient compliance and the side effects. Methods: From September 2007 to January 2008, 59 patients who had previously undergone screening colonoscopy with 4 L PEG and had been diagnosed with colonic polyps were admitted for polypectomy. The colonoscopists, who were unaware of the preparation that was administered, evaluated the adequacy of the bowel cleansing. Detailed questionnaires were also used to assess patient compliance, the difficulty of bowel preparation, side effects and patient preference. Results: The physician's evaluation of the colon cleansing showed better adequacy with 4 L PEG than with 2 L PEG plus bisacodyl (p＜0.05). There was no difference in patient compliance between the 2 bowel preps. The patients in the 2 L PEG plus bisacodyl group tolerated the bowel preparation more easily than the patients in the 4 L PEG (81.4% vs. 15.3%, respectively). Moreover, the scores of the visual analog scale for the difficulty of bowel preparation were 5.8±2.3 in the 4 L PEG group and 3.2±1.9 in the 2 L PEG plus bisacodyl (p＜0.01). The majority (89.8%) of the patients preferred 2 L PEG plus bisacodyl (p＜0.001). The 2 L PEG plus bisacodyl group revealed less nausea, vomiting and sleep discomfort (p＜0.05), but they had more abdominal pain (p＜0.01). Conclusions: 2 L PEG plus bisacodyl is not as effective as the standard 4 L PEG for colon cleansing. However, 2 L PEG plus bisacodyl can be used for patients who have difficulty drinking a large amount of PEG. (Korean J Gastrointest Endosc 2008;37:167-173)

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Acute Renal Failure Caused by Oral Polyethylene Glycol Ingestion: Yeon Joo Chun, M.D., Min Kyung Pak, M.D., Jin Su Kim, M.D., Hyung Keun Kim, M.D., Young Seok Cho, M.D., Hiun Suk Chae, M.D., Sok Won Han, M.D., Kyu Yong Choi, M.D. and Hye Kyung Lee, M.D.*; Korean J Gastrointest Endosc 2007;34(3):161-163. Published online March 30, 2007

Abstract PDF: Polyethylene glycol (PEG) electrolyte lavage solution and sodium phosphate solution are used for bowel cleansing before performing colonoscopy. PEG electrolyte lavage solution is the most widely used because PEG is absorbed by intestinal mucosa in only very small amounts and it very well cleans the bowels. The minor side-effects associated with PEG solution, i.e., nausea, vomiting and abdominal distention, are relatively common. However, PEG electrolyte lavage solution-induced acute renal failure has rarely been reported on. We report here on a case of acute renal failure after bowel preparation with using polyethylene glycol. (Korean J Gastrointest Endosc 2007; 34:161⁣163)

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A Prospective Randomized Trial Comparing Divided Dose of Polyethylene Glycol Solution with Stimulant Laxative Plus Low Dose Polyethylene Glycol Solution for Colon Cleansing: Jin Kwan Kim, M.D., Hoon Cho, M.D., Yeung Muk Kim, M.D., Kang Min Kim, M.D., Sung Nam Park, M.D., Moo Yeol Lee, M.D. and Joon Sang Lee, M.D.; Korean J Gastrointest Endosc 2006;33(1):1-5. Published online July 30, 2006

Abstract PDF: Background
/Aims: This study compared the efficacy and patient's tolerance between those given a divided dose of a polyethylene glycol solution (PEG) and those given a stimulant laxative plus a reduced dose of PEG. Methods: 190 consecutive patients for colon cleasing were randomized into 3 groups. In group A, 2 L of PEG was administered on the evening prior to the colonoscopy followed by 2 L of the same solution on the morning of colonoscopy. In group B, 2 L of PEG was administered in the morning only. In group C, 2 bisacodyl tablets (10 mg) were administered on the evening prior to colonoscopy and 2 L of PEG was administered in the morning. The patients completed a questionnaire to assess their tolerance to the bowel preparation before the colonoscopy. The endoscopists scored the adequacy of the bowel preparation using the Ottawa scale along with their satisfaction with the quality of the procedure. Results: While 4 patients (6.7%) could not completely take the recommended dose in group A, all patients in groups B and C could take the recommended dose (p=0.012). The patients in Group B had a better tolerance and fewer side effects than those in Group A (p=0.01). A higher adequacy of bowel preparation was observed in group A than in group B (p=0.000) and there appeared to be a higher adequacy of bowel preparation in Group C than in Group B (p=0.06). Conclusions: The 2 L PEG solution only does not appear to be as effective as a bowel cleansing agent for colonoscopy compared with the divided 4 L PEG solution. No statistical difference in the side effects and efficacy was observed between the divided 4 L PEG solution and the combination of bisacodyl 10 mg with 2 L of a PEG solution. (Korean J Gastrointest Endosc 2006;33:1⁣5)

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Comparision of Single Versus Split-dose of Polyethylene Glycol-electrolyte Solution for Colonoscopy Preparation: Sang Hoon Kim, M.D., Dong Il Park, M.D., Seung Ha Park, M.D., Hong Joo Kim, M.D., Yong Kyun Cho, M.D., In Kyung Sung, M.D., Chong Il Sohn, M.D., Woo Kyu Jeon, M.D. and Byung Ik Kim, M.D.; Korean J Gastrointest Endosc 2005;30(4):194-198. Published online April 30, 2005

Abstract PDF: Background
/Aims: Although polyethethylene glycol (PEG) solution is widely used for bowel preparation, it is difficult to drink a large amount of fluid in a short period of time. We compared the quality of bowel preparation and compliance between the single-dose group and split-dose group. Methods: Two hundred seventeen patients undergoing outpatient colonoscopy were randomly assigned to receive either 4 litre (L) of PEG solution (n=104, single- dose group) on the day of colonoscopy or 2 L of PEG solution on the day before colonoscopy and then 2 L of same solution on the day of colonoscopy (n=113, split- dose group). The quality of bowel preparation was assessed using Ottawa scale. Cecal intubation time, compliance and side effects were assessed. Results: Split-dose group showed the better quality of bowel preparation than single-dose group (4.75⁑2.45 vs 5.52⁑2.24, p＜0.05) because of lower residual volume scale. Patients who experienced very difficulty during ingestion (0.95% vs 5.8%) and left out more than 25% of PEG solution (3.5% vs 8.7%) were greater in single-dose group. There was no difference of side effects between two groups. Conclusions: Split-dose PEG preparation could be the useful method in than single-dose in colonoscopy preparation. (Korean J Gastrointest Endosc 2005;30:194⁣198)

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대장 내시경을 위한 장 세척 과정 중 발생한 Mallory - Weiss 증후군 2 예 ( Two Cases of Mallory - Weiss Syndrome During Bowel Preparation for Colonoscopy ): Korean J Gastrointest Endosc 2001;23(2):118-121. Published online November 30, 2000

Abstract PDF: Polyethylene glycol solutions have been usually available for clinical use since 1980 and been considered a standard method of bowel preparations for colonoscopy. There have been many reports about minor complications such as nausea and bloating associated with their use, which are frequently occurred. After ingestion of polyethylene glycol, vomiting occurrs less frequently but it can make major complication such as Mallory-Weiss syndrome and aspiration pneumonia. We have reported here two cases of Mallory-Weiss syndrome, which were occurred after ingestion of polyethylene glycol solution for colonoscopy. (Korean J Gastrointest Endosc 2001;23:118-121)

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대장 내시경 검사를 위한 전처치제로서의 Balanced Lavage Solution (Fortran )의 임상 성적 ( A Randomized Prospective Trial Comparing a New Polyethylene Glycol Based Lavage Solution with the Standard Polyethylene Glycol Solution in the Preparation of Patients Undergoing Colonoscopy (Clinical trial of new PEG solution in bowel preparation) ): Korean J Gastrointest Endosc 2000;20(3):171-176. Published online November 30, 1999

Abstract PDF: Background
/Aims: Adequate preparation of the bowel is essential for accurate colonoscopic examination. Standard polyethylene glycol solution had been used as a bowel cleansing premedication. But many patients dislike the taste and saltiness of the polyethylene glycol solution. Comparison has made between colonic preparation with a new polyethylene glycol based solution that reduced the salt content and added flavoring in attempt to improve the palatability and to encourage patient compliance with the standard polyethylene glycol solution. Methods: One hundred patients were randomized to receive either the new polyethylene glycol solution or the standard polyethylene glycol solution for their bowel cleansing preparation. Two gastroenterologists performing the colonoscopies were made unaware of the type of the preparation. The cleansing score and amount of residual fluids in each colonic segment was then evaluated. Results: There was no significant difference in the colonic cleansing score and amount of residual fluids between two groups. Patients' compliance was higher for the new polyethylene glycol solution group than for the standard polyethylene glycol group. There was no difference in side effects of bowel cleansing solutions. Conclusion: The new polyethylene glycol solution as a bowel cleansing method has a higher patient compliance rate and is as effective as the standard polyethylene glycol solution.

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대장내시경 전처치제로서 Sodium Phosphate 와 Polyethylene Glycol 용액의 전향적 비교 분석 ( A Prospective Endoscopic Blind Trial Comparing Precolonoscopy Bowel Cleansing Methods ): Korean J Gastrointest Endosc 1999;19(3):347-353. Published online November 30, 1998

Abstract PDF: Background
/Aims: Although some authors have suggested that sodium phosphate (NaP) is more effective than polyethylene glycol (PEG) in bowel cleansing, there has been no crossover study proving the superiority of NaP over PEG in bowel cleansing and patients' compliance. The aim of this study was to compare the two solutions for colonoscopy, PEG and NaP, through crossover design with regard to patients' compliance, cleansing ability and side effects. Methods: Thirty patients underwent two separate colonoscopies for colonic polyp(s) with PEG and NaP, respectively. Before and after bowel preparation, blood pressure, body weight, and serum biochemical parameters were measured in all patients. In addition, a detailed questionnaire was used to assess side effects and the patients' preference. The presence of bubbles, types of residual stool, and overall quality of colon cleansing were assessed by one endoscopist blinded to the type of preparation used. In each colonoscopy, two biopsy specimens were taken at rectum. Results: In the NaP group, but not in the PEG group, there were significant changes in several biochemical parameters including sodium ( +3.0 +- 3.0 mEq/L), potassium ( -0.3 +- 0.3mEq/L), calcium ( -0.5 +- 0.5 mg/dL), phosphorus ( +3.9 +- 2.2 mg/dL) and osmolarity ( +10.1 +- 9.3 mOsm/kg) after bowel preparation. In addition, the degree of body weight change was greater with NaP ( -2.2 +- 2.3 kg) than with PEG ( -1.2 +- 2.0 kg) (p=0.06) and the formation of bubbles that disturb luminal observation was more frequently found in the NaP group (p<0.01). There was no difference, however, in the type of residual stool and the overall quality of bowel preparation between the two groups and no significant mucosal change was noted after bowel preparation in both groups. Moreover, PEG was found to be more difficult to take than NaP (p<0.05) and among the 30 patients, 26 (87%) preferred NaP, while only two favored PEG (p<0.01). Conclusions: We conclude that NaP can replace PEG at least in patients with good general condition. Further studies to decrease the incidence of bubbles and to establish subgroups suitable for NaP are needed. (Korean J Gastrointest Endosc 19: 347∼353, 1999)

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