Efficacy of Bisacodyl Given as Part of a Polyethylene Glycol-based Bowel Preparation Prior to Colonoscopy in Hospitalized Patients: A Prospective Ramdomized Trial

Ki Bae Bang; Eun Haeng Jeong; Woo Shin Jeong; Hyun Beom Chae; Nam Hee Kim; Tae Hoon Lee; Ji Yeon Kim; Yoon Suk Jung; Jung Ho Park; Chong Il Sohn; Kyu Yong Choi; Dong Il Park

doi:10.4166/kjg.2014.64.5.268

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Bang, Jeong, Jeong, Chae, Kim, Lee, Kim, Jung, Park, Sohn, Choi, and Park: Efficacy of Bisacodyl Given as Part of a Polyethylene Glycol-based Bowel Preparation Prior to Colonoscopy in Hospitalized Patients: A Prospective Ramdomized Trial

Original Article

Korean J Gastroenterol 2014;64(5):268-277.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.64.5.268

Efficacy of Bisacodyl Given as Part of a Polyethylene Glycol-based Bowel Preparation Prior to Colonoscopy in Hospitalized Patients: A Prospective Ramdomized Trial

Ki Bae Bang, Eun Haeng Jeong, Woo Shin Jeong, Hyun Beom Chae, Nam Hee Kim, Tae Hoon Lee, Ji Yeon Kim, Yoon Suk Jung, Jung Ho Park, Chong Il Sohn, Kyu Yong Choi, Dong Il Park

Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Dong Il Park, Department of Internal Medicine, Kangbuk Samsung Hospital, 29 Saemunan-ro, Jongno-gu, Seoul 110-746, Korea. Tel: +82-2- 2001-2001, Fax: +82-2-2001-8555, E-mail: diksmc.park@samsung.com

Received 25 June 201417 September 2014 Accepted 17 September 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Inpatient status can cause inadequate bowel preparation. The majority of previous studies regarding bowel preparation have focused on comparing the effects of different purgative regimens in outpatients. However, data on bowel preparation for inpatients are lacking. The aim of this study was to investigate whether bisacodyl plus polyethylene glycol (PEG) can improve bowel preparation in hospitalized patients.

Methods

A prospective, randomized and observer-blind study was performed. A total of 196 hospitalized patients undergoing colonoscopy were randomized to receive 4 L PEG (PEG only group) or 4 L PEG+ bisacodyl 10 mg (bisacodyl added group). The adequacy of bowel preparation was scored using the Ottawa bowel preparation scale.

Results

One hundred and eighty-three subjects completed the study; 96 in the bisacodyl added group and 87 in the PEG only group. There were no significant differences between the bisacodyl added group and the PEG only group with respect to the score of bowel cleansing (3.59±2.81 vs. 3.82±3.03, p=0.607), quality of bowel cleansing (adequate preparation 89.6% vs. 85.1%, p=0.380), and overall adverse events (66.7% vs. 52.9%, p=0.057). However, a larger proportion of patients in the PEG only group were able to ingest the entire solution as prescribed than in the bisacodyl added group (98.9% vs. 75.0%, p<0.001).

Conclusions

In hospitalized patients, the quality of bowel preparation did not differ depending on whether bisacodyl is added or not. In addition, patient compliance based on consumption of cleansing agent was better in the PEG only group.

Keywords: Bowel preparation, Bisacodyl, Polyethylene glycols, Inpatients

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Fig. 1.

Flow sheet of study. PEG, polyethylene glycol.

Fig. 2.

Comparison of polyethylene glycol (PEG) ingestion between the two groups. The amount of ingested PEG was significantly greater in the 4 L PEG only group than in the 4 L PEG+bisacodyl group (p <0.001).

Fig. 3.

Patients’ stress to the bowel preparation. 4 L PEG+ bisacodyl 10 mg group suffered more severe stress than 4 L PEG only group (p=0.003).

Table 1.

Baseline Characteristics of the Patients

Characteristic	PEG 4 L only (n=87)	PEG 4 L+bisacodyl 10 mg (n=96)	p-value
Age (yr)	58.79±12.15	57.80±12.26	0.584
Male/female	45/42	55/41	0.450
Height (cm)	161.55±8.49	163.56±9.48	0.135
Weight (kg)	62.10±11.43	64.67±13.48	0.169
BMI (kg/m²)	23.69±3.34	24.05±3.69	0.503
Constipation by Rome III	7 (8.0)	10 (10.4)	0.581
Time of colonoscopy			0.152
Morning	37 (42.5)	51 (53.1)
Afternoon	50 (57.5)	45 (46.9)
Indication for CFS			0.694
Screening	11 (12.6)	13 (13.5)
Surveillance	4 (4.6)	2 (2.1)
Change in Bowel habits	6 (6.9)	7 (7.3)
Stool caliber change	1 (1.1)	0
Melena/hematochezia	6 (6.9)	7 (7.3)
Abdominal pain/discomfort	10 (11.5)	13 (13.5)
Anemia	4 (4.6)	1 (1.0)
Weight loss	1 (1.1)	0
For CPP or EMR	44 (50.6)	53 (55.2)
Operation history			0.398
Low risk operation	20 (23.0)	18 (18.8)
High risk operation	8 (9.2)	5 (5.2)
Previous colonoscopy	65 (74.7)	71 (74.0)	0.907

Values are presented as mean±SD or n (%).

PEG, polyethylene glycol; CFS, colonfibroscopy; CPP, colon polypectomy; EMR, endoscopic mucosal resection.

Table 2.

Adequacy of Bowel Cleansing according to the Ottawa Bowel Preparation Scale

Segment	Score	PEG 4 L only (n=87)	PEG 4 L+bisacodyl (n=96)	p-value
Right colon	Excellent (0)	18 (20.7)	19 (19.8)	0.648
	Good (1)	40 (46.0)	53 (55.2)
	Fair (2)	18 (20.7)	15 (15.6)
	Poor (3)	9 (10.3)	6 (6.3)
	Inadequate (4)	2 (2.3)	3 (3.1)
Mid colon	Excellent (0)	30 (34.5)	35 (36.5)	0.850
	Good (1)	39 (44.8)	46 (47.9)
	Fair (2)	13 (14.9)	10 (10.4)
	Poor (3)	3 (3.4)	4 (4.2)
	Inadequate (4)	2 (2.3)	1 (1.0)
Rectosigmoid colon	Excellent (0)	35 (40.2)	36 (37.5)	0.615
	Good (1)	35 (40.2)	47 (49.0)
	Fair (2)	10 (11.5)	9 (9.4)
	Poor (3)	6 (6.9)	4 (4.2)
	Inadequate (4)	1 (1.1)	0 (0)
Fluid quantity		0.71±0.36	0.76±0.66	0.987
Total score	Cleanliness+fluid	3.82±3.03	3.59±2.81	0.607
Overall success	0, 1, 2	74 (85.1)	86 (89.6)	0.380

Values are presented as mean±SD or n (%).

The Ottawa Scale scores range from 0 (perfect) to 14 (solid stool in each colon segment and lots of fluid, i.e., completely unprepared colon).

Right colon, cecum and ascending colon; mid colon, transverse colon and descending colon.

Overall success was considered if colon cleansing on the Ottawa scale was rated excellent, good, or fair at the all of colon segment.

Table 3.

Comparison between Morning Colonoscopy and Afternoon Colonoscopy according to the Ottawa Bowel Preparation Scale

Segment	Score	Morning (n=88)	Afternoon (n=95)	p-value
Right colon	Excellent (0)	19 (21.6)	18 (18.9)	0.752
	Good (1)	46 (52.3)	47 (49.5)
	Fair (2)	15 (17.0)	18 (18.9)
	Poor (3)	5 (5.7)	10 (7.8)
	Inadequate (4)	3 (3.4)	2 (2.1)
Mid colon	Excellent (0)	33 (37.5)	32 (33.7)	0.419
	Good (1)	42 (47.7)	43 (45.3)
	Fair (2)	10 (11.4)	13 (13.7)
	Poor (3)	1 (1.1)	6 (6.3)
	Inadequate (4)	2 (2.3)	1 (1.1)
Rectosigmoid colon	Excellent (0)	39 (44.3)	32 (33.7)	0.185
	Good (1)	37 (42.0)	45 (47.4)
	Fair (2)	9 (10.2)	10 (10.5)
	Poor (3)	2 (2.3)	8 (8.4)
	Inadequate (4)	1 (1.1)	0 (0)
Fluid quantity		0.67±0.58	0.80±0.69	0.284
Total score	Cleanliness+fluid	3.41±2.79	3.97±3.02	0.195
Overall success	0, 1, 2	79 (89.8)	81 (87.1)	0.646

Values are presented as mean±SD or n (%).

The Ottawa Scale scores range from 0 (perfect) to 14 (solid stool in each colon segment and lots of fluid, i.e., completely unprepared colon).

Right colon, cecum and ascending colon; mid colon, transverse colon and descending colon.

Overall success was considered if colon cleansing on the Ottawa scale was rated excellent, good, or fair at the all of colon segment.

Table 4.

Quality Indicators of Adequate Colonoscopy

Characteristic	PEG 4 L only (n=87)	PEG 4 L+bisacodyl (n=96)	p-value
Cecal intubation	86 (98.9)	96 (100.0)	0.475
Time to reach the cecum (min)	4.8±3.8	4.4±4.1	0.415
Withdrawal time (min)	16.3±13.5	14.7±11.9	0.413
Total procedure time (min)	21.1±14.6	19.1±13.0	0.324
Polyp detection
Any polyp	76 (87.4)	85 (88.5)	0.806
Any diminutive polyp (≤5 mm)	50 (57.5)	61 (63.5)	0.401
Multiple polyps (≥3)	36 (41.4)	45 (46.9)	0.455
Adenoma detection	59 (67.8)	61 (63.5)	0.543

Values are presented as mean±SD or n (%).

PEG, polyethylene glycol.

Table 5.

Adverse Effects of Bowel Preparation

Characteristic	PEG 4 L only (n=87)	PEG 4 L+bisacodyl (n=96)	p-value
Adverse events	46 (52.9)	64 (66.7)	0.057
Vomiting/nausea	29 (33.3)	41 (42.7)	0.231
Abdominal pain	3 (3.4)	7 (7.3)	0.406
Abdominal distension	20 (23.0)	29 (30.2)	0.351
Tenesmus	3 (3.4)	7 (7.3)	0.406
Sleep disturbance	3 (3.4)	9 (9.4)	0.20

Values are presented as n (%).

PEG, polyethylene glycol.

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