Department of Gastroenterology, Valduce Hospital, Como, Italy.
Am J Gastroenterol. 2010 Mar;105(3):675-81. doi: 10.1038/ajg.2009.598. Epub 2009 Oct 20.
Patients' compliance with and tolerance of large-volume polyethylene glycol electrolyte solution (PEG-ES) have prompted continuous investigation with alternative forms of cleansing. High-dose senna is superior to PEG-ES for the quality of bowel cleansing, patient compliance, and tolerance, but its acceptance may be influenced by the incidence of abdominal pain. We hypothesized that a combination of half doses of PEG-ES and senna could minimize the incidence of abdominal pain without affecting the quality of bowel preparation.
This randomized, investigator-blinded trial has been conducted on consecutive outpatients scheduled for elective colonoscopy at a single community-based hospital. Patients were randomly assigned to receive either 12 tablets of 12 mg senna and 2 l of PEG-ES (half-dose group, HDG) or 24 tablets of senna divided in two doses (senna group, SG) the day before colonoscopy. The main outcome measures were the quality of colon cleansing (Aronchick scoring scale) and the incidence of preparation-related abdominal pain. Secondary outcome measures were patients' compliance with the cleansing regimen, overall tolerability, prevalence of predefined side effects, and quality of right colon cleansing.
A total of 296 patients were enrolled (HDG=151 and SG=145). Overall cleansing was excellent to good in 90.1 and 88.3% patients in HDG and SG, respectively (P=0.62). Preparation-related moderate-to-severe abdominal pain was reported by 6% patients in HDG and 15.2% in SG (P=0.009). No significant differences were observed for secondary outcomes.
The regimen combining half doses of PEG-ES and senna provides high-quality bowel preparation and acceptable patient tolerance, with less abdominal pain compared with high-dose senna.
大剂量聚乙二醇电解质溶液（PEG-ES）在患者中的顺应性和耐受性促使人们不断探索替代的清洁方式。高剂量番泻叶在清洁肠道质量、患者顺应性和耐受性方面优于 PEG-ES，但它的接受程度可能会受到腹痛发生率的影响。我们假设 PEG-ES 和番泻叶的半剂量组合可以在不影响肠道准备质量的情况下，最大限度地减少腹痛的发生率。
这项随机、观察者盲法试验在一家社区医院连续纳入了接受择期结肠镜检查的门诊患者。患者被随机分配接受 12 片 12mg 番泻叶和 2L PEG-ES（半剂量组，HDG）或 24 片番泻叶分两次服用（番泻叶组，SG），在结肠镜检查前一天。主要观察指标是结肠清洁质量（Aronchick 评分量表）和准备相关腹痛的发生率。次要观察指标是患者对清洁方案的依从性、整体耐受性、预定副作用的发生率以及右半结肠清洁质量。
共纳入 296 例患者（HDG=151 例，SG=145 例）。HDG 和 SG 患者的整体清洁效果分别为 90.1%和 88.3%，均为优秀至良好（P=0.62）。HDG 组有 6%的患者报告有中度至重度与准备相关的腹痛，SG 组有 15.2%（P=0.009）。次要观察指标无显著差异。
PEG-ES 和番泻叶的半剂量组合方案可提供高质量的肠道准备，且患者耐受性可接受，与高剂量番泻叶相比，腹痛发生率更低。
