September 01, 2014
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Polyethylene glycol superior to Miralax, Gatorade for bowel preparation before colonoscopy

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A combination of Miralax and Gatorade for bowel preparation before colonoscopy was inferior to polyethylene glycol in terms of preparation quality, and did not improve polyp detection or rate of adverse effects, according to new research data.

“Adequate bowel preparation prior to colonoscopy is essential for identification of polyps and cancers,” Matthew L. Bechtold MD, FASGE, FACG, University of Missouri Health Systems, told Healio.com/Gastroenterology. “Many choices are now available for bowel preparation, including the combination of Miralax with Gatorade. However, a recent meta-analysis demonstrated that Miralax with Gatorade as a bowel preparation resulted in substantially fewer satisfactory bowel preparations as compared to 4 liters polyethylene glycol 3350 with electrolytes (PEG), regardless of split-dosing or adding bisacodyl.”

Matthew L. Bechtold

Bechtold and colleagues compared the efficacy of polyethylene glycol (PEG) with the lower volume and more palatable alternative of combined Miralax and Gatorade (MG) by performing a meta-analysis in January of five recent randomized controlled trials (RCTs). The RCTs compared quality of bowel preparation, patient tolerance and polyp detection among 1,418 patients (mean age range, 53.8 to 61.3 years) who used MG (238-255 g in 1.9 L) or PEG 3350 with electrolytes (3.8-4 L) before colonoscopy.

Satisfactory bowel preparation occurred in 89.7% of MG users vs. 90.8% of PEG users, representing significantly fewer satisfactory bowel preparations with MG (OR=0.65; 95% CI, 0.43-0.98). There was a greater proportion of patients willing to repeat preparation with MG, however, compared with PEG (92.6% vs. 66.7%; OR=7.32; 95% CI, 4.88-10.98). There were no major differences between MG and PEG regarding polyp detection (48.6% vs. 50.2%; OR=.94; 95% CI, 0.71-1.24), nausea (9.6% vs. 11%; OR=.88; 95% CI, 0.46-1.72), cramping (6.4% vs. 5.8%; OR=1.09; 95% CI, 0.47-2.52) or bloating (10.4% vs. 15.5%; OR=.81; 95% CI, 0.43-1.51). Subgroup analysis showed similar results when comparing split-dose preparations.

“No significant differences were discovered between the two groups for nausea, cramping, and bloating,” Bechtold said. “However, patients were more willing to repeat the [MG] bowel preparation. Therefore, [MG] may not be the ideal first-line bowel preparation for patients undergoing screening colonoscopy.”

“Our meta-analysis shows that despite patients being more willing to repeat the MG preparation, MG is an inferior bowel preparation as compared with PEG,” the researchers wrote. “Therefore, the role of MG seems to be as an alternative to PEG only when the patient is unable to tolerate or is simply unwilling to take split-dose PEG.”

Disclosure: The researchers report no relevant financial disclosures.