White Diet with split-dose Picosalax is preferred, better tolerated, and non-inferior to day-before clear fluids with polyethylene glycol plus sodium picosulfate-magnesium citrate for morning colonoscopy: A randomized, non-inferiority trial.

BACKGROUND AND AIM

Bowel preparations with polyethylene glycol (PEG) and clear fluids are often poorly tolerated. We compared an innovative low-residue White Diet and low-volume, split-dose Picosalax with the standard preparation at our institution of day-before clear fluids and combination PEG plus sodium picosulfate/magnesium citrate (SPMC).

METHODS

Adults undergoing morning colonoscopy were randomized to either the White Diet and split-dose, two sachets of Picosalax (WD/PICO) or day-before clear fluids and 1-L PEG plus two sachets of SPMC (CF/PEG + SPMC). The primary endpoint was successful bowel preparation defined by an Ottawa bowel preparation score ≤ 6. An intention-to-treat analysis with a predefined non-inferiority margin of 15% was used to compare efficacy.

RESULTS

A total of 250 patients were randomized (125 WD/PICO and 125 CF/PEG + SPMC). WD/PICO was non-inferior to CF/PEG + SPMC for successful bowel preparation by intention-to-treat analysis (58% WD/PICO 62% CF/PEG + SPMC, 95%CI: -14.2 to 6.2%) and per-protocol analysis (64% WD/PICO 65% CF/PEG + SPMC, 95%CI: -11.3 to 9.4%). Patients in the WD/PICO group reported greater satisfaction with the diet ( < 0.001), greater ease of following the diet ( < 0.001), and improved experience compared with prior colonoscopy ( < 0.0001), less bloating ( = 0.02), less weakness ( = 0.046), less hunger ( < 0.0001), and less interference with daily activities ( = 0.001). Procedure/withdrawal times and adenoma detection rates were similar between groups.

CONCLUSION

Bowel preparation with the White Diet and low-volume, split-dose Picosalax was preferred and better tolerated without detriment to bowel preparation success compared with clear fluids and combination PEG plus SPMC for morning colonoscopy.