with PEG-ES Lavage and Aqueous Sodium Phosphate as Bowel Preparation for Elective Colonoscopy:
a Prospective, Randomized, Single Blinded Trial

Joseph J. Fiorito, MD, Joan A Culpepper-Morgan, MD, Scott G. Estabrook, MD, Patricia Scofield, LPN, Victor Usatii, MD and Jodi Cuomo, RpH2. Gastroenterology, Danbury Hospital, Danbury, CT United States
The American College of Gastroenterology
Annual Scientific Meeting 2006

Purpose: Hydrotherapy is a method of colon cleansing using constant warm water lavage using a contained temperature and pressure controlled device administered by a trained technician. The aim of this study was to compare the efficacy and patient acceptance of same-day hydrotherapy (HYDRO) with polyethylene glycol-electrolyte lavage (PEG-ES) and aqueous sodium phosphate (ASP) in patients undergoing elective colonoscopy.

Methods: Consecutive outpatients referred for elective colonoscopy were randomly assigned to receive 4 L PEG-ES (n=55), two doses of aqueous sodium phosphate (n=52), or same day hydrotherapy (n=53), as bowel preparation. The endoscopists were blinded to the method of preparation. The overall quality of the colon cleansing was evaluated with respect to the adequacy of visualization of the right, transverse, and left colon. Patients were asked to rate the preparation with respect to ease, convenience, and comfort using structured, validated questionnaire. Results were analyzed using the chi square test.

Results: Endoscopists rated the quality of colon cleansing as good for the right: 62% ASP, 49% PEG-ES, and 92% HYDRO (p<0.001).

For the transverse colon: 80% Asp, 63% PEG-ES, and 100% HYDRO (p<0.001). For the left colon: 84% ASP, 67% PEG-ES, and 98% HYDRO (p<0.001). Patients rated the preparations as easy: 87% ASP, 56% PEG-ES, 96% HYDRO (p<0.001). Patients rated convenience: 61% ASP, 79% PEG-ES, and 98% HYDRO (p<0.001). Patients rated for comfort: 71% ASP, 36% PEG-ES, and 94% HYDRO (p<0.001). Patients were asked if they wanted a different preparation for the next colonoscopy: 48% ASP, 60% PEG-ES, and 4% HYDRO (p<0.001).

Conclusion: The quality of colon cleansing, overall tolerance, comfort, and convenience were significantly better for HYDRO. In this study ASP was better than PEG-ES for the same parameters. Hydrotherapy should be further investigated as a viable alternative to PEG-ES and ASP for bowel preparation prior to colonoscopy.