February 15, 2019
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Comparative study finds most effective bowel preps

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A comparison study, published in the American Journal of Gastroenterology, found the most effective and best tolerated bowel preparations, which researchers hope will help provide some guidance on which one of the many commercially available options to use.

Christopher V. Almario, MD, MSHPM, of the department of medicine at Cedars-Sinai Medical Center, and colleagues wrote that inadequate preparation occurs in 25% of colonoscopies and having data on the most effective preps could improve polyp detection.

“There are more than 10 commercially available bowel preps, with each varying in volume, tolerability, and formulation,” they wrote. “Despite the importance of bowel cleansing, national societies provide minimal guidance regarding which preps are best tolerated and most eective or how best to navigate among the available options.”

Researchers included patients aged at least 18 years in a prospective comparative effectiveness study of seven currently available bowel preps and measured their impact on cleansing before an outpatient colonoscopy. The bowel preps tested were GoLYTELY (Braintree Laboratories), MoviPrep (Salix), MiraLAX (Bayer) with Gatorade (PepsiCo), Prepopik/Clenpiq (Ferring), Suprep (Braintree), magnesium citrate, and OsmoPrep (Salix). The endoscopist performing each procedure was free to use the prep of their choice, and the primary outcome was bowel cleansing quality measured by the Boston Bowel Preparation Scale (BBPS).

In 4,339 colonoscopies performed by 75 endoscopists, researchers found that Magnesium citrate, MiraLAX with Gatorade, MoviPrep, OsmoPrep, Prepopik/Clenpiq and Suprep all had significantly higher prep tolerability when compared with GoLYTLEY (all P < .05). Researchers observed higher total BBPS scores with Suprep (7.28±1.66; P < .001), MoviPrep (7.11±1.62; P = .004), and MiraLAX (7.09±1.64; P < .001) vs. GoLYTLEY (6.67±1.87), while there was no significant difference among the other methods.

Split-prep dosing was associated with better cleansing, while men, opioid and tricyclic antidepressant users, and patients with diabetes and cirrhosis had worse cleansing (all P < .05).

“Our study reveals that MiraLAX with Gatorade, MoviPrep, and Suprep are better tolerated and associated with superior bowel cleansing compared with GoLYTELY,” Almario and colleagues wrote. “Future large, pragmatic, multicenter comparative eectiveness studies are needed to conrm these ndings and to extend them to evaluate the impact on other outcomes, including ADR and cancer detection and prevention.” – by Alex Young

Disclosures: Almario reports receiving a consultant fee from Bayer. Please see the full study for all other authors’ relevant financial disclosures.