Bowel Preparation, the First Step for a Good Quality Colonoscopy

In this issue of Intestinal research, Kang et al. investigate the efficacy and tolerability of bowel preparation for afternoon colonoscopy.8 Study subjects were randomized to one of two therapeutic dosing strategies: the same-day two sachets of picosulfate group (n=97, group A) vs. conventional split-dose 4 L polyethylene glycol (PEG) group (n=99, group B).The primary endpoint was bowel preparation success assessed by using the Ottawa scale.Patients' tolerability was assessed using a questionnaire immediately before colonoscopy to evaluate patient tolerability, adverse events, and sleep quantity.The number of polyps and adenomas detected were measured.The Ottawa score of the total colon was 4.05±1.56 in the group A and 3.80±1.55 in the group B (P =0.255).Bowel preparation success was achieved in 61.5% of the same-day picosulfate group vs. 71.3% of 4 L PEG group, which failed to reach statistical significance (P=0.133).However, tolerability of the group A regimen was superior to the group B regimen (P<0.001).The overall incidence of adverse events was fewer in the same-day picosulfate group (P=0.037).In addition, the proportion of patients who slept at least 80% of their usual sleeping hours was higher in group A than group B (87.8 vs. 56.4%,P <0.001).Adenoma detection rate was similar between the two groups (31.3% for group A vs. 34.3%for group B; P =0.651).These results suggest that bowel preparation with the same-day picosulfate regimen may be similar in cleansing efficacy and superior in the tolerability and adverse event profile to the conventional split-dose 4 L PEG regimen.The conclusion of this study may have several implications.First, safety is an important virtue.Therefore, safer adverse event profile of the same-day picosulfate regimen is meaningful by itself.Second, shortening of bowel preparation duration within a single day will less severely disturb a Bowel Preparation, the First Step for a Good Quality Colonoscopy