Volume 4, Issue 2, December 2020, Page: 54-62
A Randomized Clinical Trial Evaluating Mannitol, Lactitol, and Polyethylene Glycol Macrogol as Oral Solutions for Colonoscopy Preparation
Lourianne Nascimento Cavalcante, Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil; Medicine School, Federal University of Bahia, Salvador, Bahia, Brazil
Adriana Ribas, Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil
Alexandre Pithon Lins, Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil
Luciana Rodrigues Leal da Silva, Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil
Flora Maria Lorenzo Fortes, Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil
Valdeck Sodre Bispo Jr, Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil
Marcus Vinicius Matos de Almeida, Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil
Maira Cintra de Oliveira, Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil
Camila Silveira, Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil
Marcos Clarencio Batista, Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil
Igelmar Barreto Paes, Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil; Medicine School, Federal University of Bahia, Salvador, Bahia, Brazil
Received: Aug. 11, 2020;       Accepted: Aug. 26, 2020;       Published: Sep. 23, 2020
DOI: 10.11648/j.ijg.20200402.16      View  37      Downloads  16
Abstract
Colonoscopy is an important tool for diagnosing and treating bowel injuries and reducing colorectal cancer incidence. Adequate bowel preparation is necessary to ensure the effectiveness of the procedure for detecting injuries. In this trial the aim was to compare effectiveness of lactitol, mannitol, and polyethylene glycol (PEG) oral solutions for bowel cleansing prior to colonoscopy. This is a randomized, blinded clinical trial. The primary endpoint was to evaluate the adequacy of colon cleansing according to the Boston Bowel Preparation Scale (BBPS). A total of 294 patients were randomized into three groups. The overall adequacy of bowel cleansing was achieved in 98.8% in the mannitol, followed by 93.5% in the lactitol and 92.3% in the PEG group. When comparing lactitol and mannitol, the efficacy to bowel preparation was greater in the mannitol group, but without statistical significance (P=0.164). The adequacy to bowel preparation was slightly better in the mannitol group than PEG (98.8% vs. 92.2%, respectively), but with P-value of 0.073. In adjusted analysis, the results were similar. The frequency of hypernatremia after bowel preparation was 25.3% in the mannitol group, followed by 7.3% and 5.2% in the PEG and lactitol, respectively. Considering tolerance for bowel preparation solution there was no difference between the mannitol and lactitol groups (P=0.07); but lactitol was better tolerated when compared to PEG (P=0.001). In conclusion, mannitol, lactitol and PEG are effective as intestinal cleansing solutions before colonoscopy, but adverse events, taste and tolerability must be considered before choosing.
Keywords
Intestinal Preparation, Bowel Cleansing, Colonoscopy, Lactitol, Mannitol, Polyethylene Glycol
To cite this article
Lourianne Nascimento Cavalcante, Adriana Ribas, Alexandre Pithon Lins, Luciana Rodrigues Leal da Silva, Flora Maria Lorenzo Fortes, Valdeck Sodre Bispo Jr, Marcus Vinicius Matos de Almeida, Maira Cintra de Oliveira, Camila Silveira, Marcos Clarencio Batista, Igelmar Barreto Paes, A Randomized Clinical Trial Evaluating Mannitol, Lactitol, and Polyethylene Glycol Macrogol as Oral Solutions for Colonoscopy Preparation, International Journal of Gastroenterology. Vol. 4, No. 2, 2020, pp. 54-62. doi: 10.11648/j.ijg.20200402.16
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Issa IA, Noureddine M. Colorectal cancer screening: An updated review of the available options. World J Gastroenterol [Internet]. 2017 [cited 2020 May 17]; 23 (28): 5086. Available from: http://www.wjgnet.com/1007-9327/full/v23/i28/5086.htm.
[2]
Seeff LC, Richards TB, Shapiro JA, Nadel MR, Manninen DL, Given LS, et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC’s survey of endoscopic capacity. Gastroenterology [Internet]. 2004 Dec [cited 2017 Mar 5]; 127 (6): 1670–7. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0016508504016300.
[3]
Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer [Internet]. 2010 Feb 1 [cited 2020 May 5]; 116 (3): 544–73. Available from: http://doi.wiley.com/10.1002/cncr.24760.
[4]
Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, van Ballegooijen M, Kuntz KM. Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force. Ann Intern Med [Internet]. 2008 Nov 4 [cited 2020 May 5]; 149 (9): 659. Available from: http://annals.org/article.aspx?doi=10.7326/0003-4819-149-9-200811040-00244.
[5]
Brody H. Colorectal cancer. Nature. 2015.
[6]
Organisation WG, Digestive I, Alliance C, Guidelines P, Winawer S, Classen M, et al. Triagem do câncer colorretal.: 1–19.
[7]
Dozois EJ, Boardman LA, Suwanthanma W, Limburg PJ, Cima RR, Bakken JL, et al. Young-onset colorectal cancer in patients with no known genetic predisposition: can we increase early recognition and improve outcome? Medicine (Baltimore) [Internet]. 2008 Sep [cited 2019 Mar 6]; 87 (5): 259–63. Available from: https://insights.ovid.com/crossref?an=00005792-200809000-00003.
[8]
Ahnen DJ, Wade SW, Jones WF, Sifri R, Mendoza Silveiras J, Greenamyer J, et al. The increasing incidence of young-onset colorectal cancer: a call to action. Mayo Clin Proc [Internet]. 2014 Feb [cited 2019 Mar 6]; 89 (2): 216–24. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0025619613008227.
[9]
Cronin KA, Lake AJ, Scott S, Sherman RL, Noone A-M, Howlader N, et al. Annual Report to the Nation on the Status of Cancer, part I: National cancer statistics. Cancer [Internet]. 2018 Jul 1 [cited 2019 Mar 6]; 124 (13): 2785–800. Available from: http://doi.wiley.com/10.1002/cncr.31551.
[10]
Bray C, Bell LN, Liang H, Collins D YS. Colorectal Cancer Screening. WMJ [Internet]. 2017 [cited 2020 May 17]; 116 (7): 27–33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29099566?report=abstract&format=text.
[11]
Bechtold ML, Mir F, Puli SR, Nguyen DL. Optimizing bowel preparation for colonoscopy: A guide to enhance quality of visualization [Internet]. Annals of Gastroenterology The Hellenic Society of Gastroenterology; 2016 p. 137–46. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27065725.
[12]
Rex DK, Imperiale TF, Latinovich DR, Bratcher LL. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol [Internet]. 2002 Jul [cited 2017 Aug 15]; 97 (7): 1696–700. Available from: http://www.nature.com/doifinder/10.1111/j.1572-0241.2002.05827.x.
[13]
Rosa-Rizzotto E, Dupuis A, Guido E, Caroli D, Monica F, Canova D, et al. Clean Colon Software Program (CCSP), Proposal of a standardized Method to quantify Colon Cleansing During Colonoscopy: Preliminary Results. Endosc Int Open [Internet]. 2015 Jun 24 [cited 2017 Aug 15]; 03 (05): E501–7. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1392109.
[14]
Miki Jr P, Lemos CR dos R, Popoutchi P, Garcia RL dos S, Rocha JJR da, Feres O. Comparison of colon-cleansing methods in preparation for colonoscopy - Comparative efficacy of solutions of mannitol, sodium picosulfate and monobasic and dibasic sodium phosphates. Acta Cir Bras [Internet]. 2008 [cited 2017 Aug 15]; 23 (suppl 1): 108–11. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502008000700018&lng=en&tlng=en.
[15]
Beck DE, Fazio VW, Jagelman DG. Comparison of oral lavage methods for preoperative colonic cleansing. Dis Colon Rectum [Internet]. 1986 Nov [cited 2020 May 5]; 29 (11): 699–703. Available from: http://journals.lww.com/00003453-198629110-00005.
[16]
Vieira MC, Hashimoto CL, Carrilho FJ. Bowel preparation for performing a colonoscopy: prospective randomized comparison study between a low-volume solution of polyethylene glycol and bisacodyl versus bisacodyl and a mannitol solution. Arq Gastroenterol [Internet]. 2012 Jun [cited 2020 May 5]; 49 (2): 162–8. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-28032012000200012&lng=en&tlng=en.
[17]
Cohen LB, Sanyal SM, Von Althann C, Bodian C, Whitson M, Bamji N, et al. Clinical trial: 2-L polyethylene glycol-based lavage solutions for colonoscopy preparation - A randomized, single-blind study of two formulations. Aliment Pharmacol Ther. 2010.
[18]
Wexner SD, Beck DE, Baron TH, Fanelli RD, Hyman N, Shen B, et al. A consensus document on bowel preparation before colonoscopy: prepared by a Task Force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Surg Endosc [Internet]. 2006 Jul 23 [cited 2020 May 5]; 20 (7): 1161–1161. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16799744.
[19]
Miller LE, Tennilä J, Ouwehand AC. Efficacy and tolerance of lactitol supplementation for adult constipation: A systematic review and meta-analysis. Clin Exp Gastroenterol [Internet]. 2014 Jul [cited 2020 May 5]; 7 (1): 241–8. Available from: http://www.dovepress.com/efficacy-and-tolerance-of-lactitol-supplementation-for-adult-constipat-peer-reviewed-article-CEG.
[20]
Als-Nielsen B, Gluud LL, Gluud C. Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials. BMJ [Internet]. 2004; 328 (7447): 1046. Available from: http://www.bmj.com/content/328/7447/1046.
[21]
Sharma P, Sharma BC. Disaccharides in the treatment of hepatic encephalopathy. Metab Brain Dis. 2013; 28 (2): 313–20.
[22]
Emanueli A, Sacchetti G. An algorithm for the classification of untoward events in large scale clinical trials. Agents Actions Suppl [Internet]. 1980 [cited 2020 May 5]; 7: 318–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/6941682.
[23]
Holt SH, Miller JC, Petocz P, Farmakalidis E. A satiety index of common foods. Eur J Clin Nutr [Internet]. 1995 Sep [cited 2020 May 5]; 49 (9): 675–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7498104.
[24]
Lawrance IC, Willert RP, Murray K. A validated bowel-preparation tolerability questionnaire and assessment of three commonly used bowel-cleansing agents. Dig Dis Sci [Internet]. 2013 Apr 25 [cited 2017 Aug 19]; 58 (4): 926–35. Available from: http://link.springer.com/10.1007/s10620-012-2449-0.
[25]
Bozdogan H. Model selection and Akaike’s Information Criterion (AIC): The general theory and its analytical extensions. Psychometrika [Internet]. 1987 Sep [cited 2020 Jul 18]; 52 (3): 345–70. Available from: https://link.springer.com/article/10.1007/BF02294361.
[26]
Cameron AC TP. Regression analysis of count data. 53rd ed. Cambridge university press; 2013.
[27]
Zou G. A Modified Poisson Regression Approach to Prospective Studies with Binary Data. Am J Epidemiol Hopkins Bloom Sch Public Heal All rights Reserv [Internet]. 2004 [cited 2020 Jul 18]; 159 (7): 702–6. Available from: https://academic.oup.com/aje/article-abstract/159/7/702/71883.
[28]
Coutinho LMS, Scazufca M, Menezes PR. Methods for estimating prevalence ratios in cross-sectional studies. Rev Saude Publica [Internet]. 2008 [cited 2020 Jul 18]; 42 (6): 992–8. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102008000600003&lng=en&nrm=iso&tlng=pt.
[29]
Battaggia A VA. ARR, NNT, NNH, LLH... Maestro, il senso lor m’è duro! Riv QQ - Qual Qual Gen Prat. 2006; 11 (1): 2–4.
[30]
R Core Team (2013). R: A language and environment for statistical computing. R Foundation for Statistical Computing; Vienna; Austria.
[31]
Chan W-K, Saravanan A, Manikam J, Goh K-L, Mahadeva S. Appointment waiting times and education level influence the quality of bowel preparation in adult patients undergoing colonoscopy. BMC Gastroenterol [Internet]. 2011 Jul 28 [cited 2020 May 5]; 11 (1): 86. Available from: https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-11-86.
[32]
Raju GS, Gerson L, Das A, Lewis B. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology [Internet]. 2007 Nov [cited 2015 Jul 29]; 133 (5): 1694–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17983811.
[33]
Habr Gama, Angelita; Vieira, Maria José Femenias; Alves, Paulo Roberto Arruda; Sousa Junior, Afonso Henrique da Silva e; Sototuka, Jorge Kuma; Gama Rodrigues, Joaquim; Travassos VHCR. Preparo do cólon para colonoscopia: estudo prospectivo randomizado com soluçäo de manitol a 10% e com soluçäo eletrolítica contendo polietilenoglicol / Bowel preparation for colonoscopy: a prospective study with 10% mannitol solution and with electrolyte. GED gastroenterol endosc dig. 1986; 5 (4): 127–32.
[34]
CX L, Y G, YJ Z, JR Z, QS X, DF C, et al. Comparison of Polyethylene Glycol versus Lactulose Oral Solution for Bowel Preparation prior to Colonoscopy. Gastroenterol Res Pract [Internet]. 2019 [cited 2020 Jul 21]; 2019. Available from: https://pubmed.ncbi.nlm.nih.gov/31097959/.
[35]
WS A, R E, I K-H, K W, AR H, JM N, et al. No Title. 2010 May 8 [cited 2020 May 5]; 375 (9726). Available from: https://linkinghub.elsevier.com/retrieve/pii/S014067361060551X.
[36]
Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med [Internet]. 2010 May 13 [cited 2020 May 5]; 362 (19): 1795–803. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20463339.
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