Department of Medicine, Division of Gastroenterology, Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA.
Clin Gastroenterol Hepatol. 2011 Apr;9(4):326-332.e1. doi: 10.1016/j.cgh.2010.11.007. Epub 2010 Nov 27.
BACKGROUND & AIMS: Successful colonoscopies require good bowel preparations-poor bowel preparations can increase medical costs, rates of missed lesions, and procedure duration. The combination of polyethylene glycol (PEG) 3350 without electrolytes (MiraLAX; Schering-Plough Healthcare Products, Inc, Kenilworth, NJ) and 64 oz of Gatorade (PepsiCo, Inc, Purchase, NY) has gained popularity as a bowel preparation regimen. However, the efficacy and tolerability of this approach has not been compared with standard bowel preparations in clinical trials. We compared split-dose (PEG) 3350 with electrolytes (GoLytely; Braintree Laboratories, Inc, Braintree, MA) with split-dose MiraLAX alone and in combination with pretreatment medications (bisacodyl or lubiprostone) to determine the efficacy and patient tolerability of MiraLAX as an agent for bowel preparation.
We performed a prospective, randomized, blinded, controlled trial at a tertiary care center. Patients (n=403) were randomly assigned to groups given GoLytely, MiraLAX, MiraLAX with bisacodyl (10 mg), or MiraLAX with lubiprostone (24 μg). MiraLAX was combined with 64 oz of Gatorade. All patients were surveyed regarding preparation satisfaction and tolerability. The Ottawa bowel preparation scale was used to grade colon cleanliness.
GoLytely was more effective at bowel cleansing (average Ottawa score, 5.1) than MiraLAX alone (average Ottawa score, 6.9) or in combination with lubiprostone (average Ottawa score, 6.8), or bisacodyl (average Ottawa score, 6.3) (P<.001). MiraLAX was associated with a trend toward longer procedure duration (P=.096). Groups given MiraLAX rated the overall experience as more satisfactory than those given GoLytely (P<.001). There were no differences between polyp detection rates (P=.346) or adverse events (P=.823).
Split-dose MiraLAX in 64 oz of Gatorade is not as effective as 4 L split-dose GoLytely in bowel cleansing for screening colonoscopies.
成功的结肠镜检查需要良好的肠道准备——肠道准备不佳会增加医疗费用、漏诊病变的几率和检查持续时间。聚乙二醇 3350 不含有电解质（MiraLAX；Schering-Plough Healthcare Products，Inc，Kenilworth，NJ）与 64 盎司佳得乐（PepsiCo，Inc，Purchase，NY）的联合使用已作为一种肠道准备方案得到普及。然而，这种方法的疗效和耐受性尚未在临床试验中与标准肠道准备进行比较。我们比较了 4 升等分剂量（PEG）3350 与电解质（GoLytely；Braintree Laboratories，Inc，Braintree，MA）与单独等分剂量 MiraLAX 以及与预处理药物（比沙可啶或鲁比前列酮）的联合使用，以确定 MiraLAX 作为肠道准备药物的疗效和患者耐受性。
我们在一家三级保健中心进行了一项前瞻性、随机、盲法、对照试验。将 403 名患者随机分配至接受 GoLytely、MiraLAX、MiraLAX 加比沙可啶（10 mg）或 MiraLAX 加鲁比前列酮（24 μg）的组。MiraLAX 与 64 盎司佳得乐混合。所有患者均接受了关于准备满意度和耐受性的调查。采用渥太华肠道准备量表对结肠清洁度进行分级。
GoLytely 在肠道清洁方面（平均渥太华评分 5.1）优于单独使用 MiraLAX（平均渥太华评分 6.9）或与鲁比前列酮（平均渥太华评分 6.8）联合使用，或与比沙可啶（平均渥太华评分 6.3）联合使用（P<.001）。与给予 GoLytely 的组相比，给予 MiraLAX 的组的操作持续时间呈延长趋势（P=.096）。给予 MiraLAX 的组总体体验评分高于给予 GoLytely 的组（P<.001）。两组之间的息肉检出率（P=.346）或不良事件（P=.823）无差异。
64 盎司佳得乐中的等分剂量 MiraLAX 与 4 升等分剂量 GoLytely 相比，在筛查性结肠镜检查的肠道清洁方面效果不佳。
