Oral Sodium Phosphate versus Polyethylene Glycol-electrolyte Lavage Solution for Colonoscopy Preparation: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LI Yaodong , WANG Yiping , PAN Tao , TIAN Ling

Department of Gastroenterology; West China Hospital; West China Medical School; Sichuan University; Chengdu 610041; China;

Corresponding author：

Keywords：

Sodium phosphate; Polyethylene glycol-electrolyte lavage solution; Colonoscopy; Systematicl review

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Objective 　To evaluate the difference of oral sodium phosphate (NaP) and polyethylene glycol-electrolyte lavage solution (PEG-ELS) in the aspects of cleansing efficacy, tolerance, and safety in clinical practice, so as to provide evidence for clinical practice.
Methods 　A systematic review of all the relevant randomized controlled trials (RCTs) was performed according the handbook of the Cochrane Collaboration. RCTs were identified from The Cochrane Library(Issue1,2004) MEDLINE(1980-2004), EMBASE(1984-2004),and CBM(1978-2004).Handsearching was also performed .RCTs comparing the two methods were selected .Tow reviewers independently assessed the quality of included trials and extracted data independently .
Results 　Eighteen trials involving 3668 patients were included .Sub-group analysis was performed. Nap tablet had higher rate of adequate cleansing quality (RR1.08,95%CI1.02 to 1.05,p=0.01).Two-day ,divided-dose oral Nap was superior in the rate of adequate cleansing quality (RR1.27,95%CI1.06 to 1.52,p=0.009). .The. rate of adequate cleansing quality in right colon of Nap was lower than PEG-ELS(RR0.79,95%CI 0.64 to 0.98,p=0.03).The rate of abdominal cramps (RR 0.84,95%CI 0.72 to 0.99),the rate of abdominal fullness (RR 0.48,95%CI 0.26 to 0.89),the rate of nausea (RR 0.65,95%CI 0.56 to 0.76)and the percentage of patients who didn’t finished their prescribed regimen (RR 0.23,95%CI0.14 to 0.36)in Nap group were lower (p lt;0.05).
Conclusions 　Compared with PEG-ELS,Nap is superior in cleansing efficacy , patients’ tolerance ,safety and economy . It is possible to promote the use of Nap in clinical practice in China .

Citation： LI Yaodong,WANG Yiping,PAN Tao,TIAN Ling. Oral Sodium Phosphate versus Polyethylene Glycol-electrolyte Lavage Solution for Colonoscopy Preparation: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2005, 05(7): 555-561. doi: Copy

1.	欧阳钦,甘华田,陈立中.磷酸钠口服清肠液结肠准备效果与安全性研究.中化消化内镜杂志, 1998;15(5):278～280.
2.	Davis GR, Santa Ana CA, Morawski SG, Fordtran JS. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion[J].Gastroenterology, 1980; 78(5 Pt 1):991-995.
3.	Vanner SJ, MacDonald PH, Paterson WG, Prentice RS, Da Costa LR, Beck IT. A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy[J]. Am J Gastroenterol, 1990; 85(4):422-427.
4.	Clarke M, Oxman AD, editors. Cochrane Reviewers’Handbook 4.1[updated June 2000]. In: Review Manager (RevMan) [Computer program] [CD/M]. Version 4.1. Oxford, England: The Cochrane Collaboration, 2000.
5.	Cohen SM, Wexner SD, Binderow SR, Nogueras JJ, Daniel N, Ehrenpreis ED, Jensen J, Bonner GF, Ruderman WB. Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods[J]. Dis Colon Rectum, 1994;37(7):689-696.
6.	David K, Chasen R, Choudhary C, Riff D, Steinberg S, Weiss E, Wruble L. Efficacy and safety of sodium phosphate tablets compared with PEG solution in colon cleansing: two identically designed, randomized, controlled, parallel group, multicenter phase III trials[J]. Gastrointest Endosc, 2001; 54(6):705-713.
7.	Marshall JB, Pineda JJ, Barthel JS, King PD. Prospective, randomized trial comparing sodium phosphate solution with polyethylene glycol-electrolyte lavage for colonoscopy preparation[J]. Gastrointest Endosc, 1993; 39(5):631-634.
8.	Henderson JM, Barnett JL, Turgeon DK, Elta GH, Behler EM, Crause I, Nostrant TT. Single-day, divided-dose oral sodium phosphate laxative versus intestinal lavage as preparation for colonoscopy: efficacy and patient tolerance[J]. Gastrointest Endosc, 1995; 42(3):238-243.
9.	Clarkston WK, Tsen TN, Dies DF, Schratz CL, Vaswani SK, Bjerregaard P. Oral sodium phosphate versus sulfate-free polyethylene glycol electrolyte lavage solution in outpatient preparation for colonoscopy: a prospective comparison[J]. Gastrointest Endosc, 1996; 43(1):42-48.
10.	Aronchick CA, Lipshutz WH, Wright SH, Dufrayne F, Bergman G. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda[J]. Gastrointest Endosc, 2000; 52(3):346-352.
11.	Chia YW, Cheng LC, Goh PM, Ngoi SS, Isaac J, Chan ST, Ti TK. Role of oral sodium phosphate and its effectiveness in large bowel preparation for out-patient colonoscopy[J]. J R Coll Surg Edinb, 1995; 40(6):374-376.
12.	Ell C, Fischbach W, Keller R, Dehe M, Mayer G, Schneider B, Albrecht U, Schuette W; Hintertux Study Group. A randomized, blinded, prospective trial to compare the safety and efficacy of three bowel-cleansing solutions for colonoscopy (HSG-01*)[J]. Endoscopy, 2003; 35(4):300-304.
13.	Frommer D. Cleansing ability and tolerance of three bowel preparations for colonoscopy[J]. Dis Colon Rectum, 1997; 40(1):100-104.
14.	Lapalus MG, Gaudin JL, Lemkecher T, Souquet JC, Wendehenne F, Peltrault C, Pontette F, Pillon M, Monier JM, Dumont O. Prospective randomized single-blind trial comparing oral sodium phosphate with polyethylene glycol for colonoscopy preparation[J]. Gastroenterol Clin Biol, 2001;25(1): 29-34.
15.	Lee J, McCallion K, Acheson AG, Irwin ST. A prospective randomised study comparing polyethylene glycol and sodium phosphate bowel cleansing solutions for colonoscopy[J]. Ulster Med J, 1999; 68(2):68-72.
16.	Martinek J, Hess J, Delarive J, Jornod P, Blum A, Pantoflickova D, Fischer M, Dorta G. Cisapride does not improve precolonoscopy bowel preparation with either sodium phosphate or polyethylene glycol electrolyte lavage[J]. Gastrointest Endosc, 2001; 54(2):180-185.
17.	Marshall JB, Barthel JS, King PD. Short report: prospective, randomized trial comparing a single dose sodium phosphate regimen with PEG-electrolyte lavage for colonoscopy preparation[J]. Aliment Pharmacol Ther, 1993; 7(6):679-682.
18.	Seinela L, Pehkonen E, Laasanen T, Ahvenainen J. Bowel preparation for colonoscopy in very old patients: a randomized prospective trial comparing oral sodium phosphate and polyethylene glycol electrolyte lavage solution[J]. Scand J Gastroenterol, 2003;38(2):216-220.
19.	Da Silva MM, Briars GL, Patrick MK, Cleghorn GJ, Shepherd RW. Colonoscopy preparation in children: safety, efficacy, and tolerance of high-versus low-volume cleansing methods[J]. J Pediatr Gastroenterol Nutr, 1997; 24(1):33-37.
20.	Thomson A, Naidoo P, Crotty B. Bowel preparation for colonoscopy: a randomized prospective trail comparing sodium phosphate and polyethylene glycol in a predominantly elderly population[J]. J Gastroenterol Hepatol, 1996; 11(2):103-107.
21.	Zwas FR, Cirillo NW, el-Serag HB, Eisen RN. Colonic mucosal abnormalities associated with oral sodium phosphate solution[J]. Gastrointest Endosc, 1996; 43(5):463-466.
22.	Ouyang Qin, Gan Huatian, Cheng Lizhong. The effective and tolerance of oral sodium phosphate for colonoscopic preparation[J]. Chinese Digestive Jounal, 1998; 15(5):278-280.

1. 欧阳钦,甘华田,陈立中.磷酸钠口服清肠液结肠准备效果与安全性研究.中化消化内镜杂志, 1998;15(5):278～280.
2. Davis GR, Santa Ana CA, Morawski SG, Fordtran JS. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion[J].Gastroenterology, 1980; 78(5 Pt 1):991-995.
3. Vanner SJ, MacDonald PH, Paterson WG, Prentice RS, Da Costa LR, Beck IT. A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy[J]. Am J Gastroenterol, 1990; 85(4):422-427.
4. Clarke M, Oxman AD, editors. Cochrane Reviewers’Handbook 4.1[updated June 2000]. In: Review Manager (RevMan) [Computer program] [CD/M]. Version 4.1. Oxford, England: The Cochrane Collaboration, 2000.
5. Cohen SM, Wexner SD, Binderow SR, Nogueras JJ, Daniel N, Ehrenpreis ED, Jensen J, Bonner GF, Ruderman WB. Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods[J]. Dis Colon Rectum, 1994;37(7):689-696.
6. David K, Chasen R, Choudhary C, Riff D, Steinberg S, Weiss E, Wruble L. Efficacy and safety of sodium phosphate tablets compared with PEG solution in colon cleansing: two identically designed, randomized, controlled, parallel group, multicenter phase III trials[J]. Gastrointest Endosc, 2001; 54(6):705-713.
7. Marshall JB, Pineda JJ, Barthel JS, King PD. Prospective, randomized trial comparing sodium phosphate solution with polyethylene glycol-electrolyte lavage for colonoscopy preparation[J]. Gastrointest Endosc, 1993; 39(5):631-634.
8. Henderson JM, Barnett JL, Turgeon DK, Elta GH, Behler EM, Crause I, Nostrant TT. Single-day, divided-dose oral sodium phosphate laxative versus intestinal lavage as preparation for colonoscopy: efficacy and patient tolerance[J]. Gastrointest Endosc, 1995; 42(3):238-243.
9. Clarkston WK, Tsen TN, Dies DF, Schratz CL, Vaswani SK, Bjerregaard P. Oral sodium phosphate versus sulfate-free polyethylene glycol electrolyte lavage solution in outpatient preparation for colonoscopy: a prospective comparison[J]. Gastrointest Endosc, 1996; 43(1):42-48.
10. Aronchick CA, Lipshutz WH, Wright SH, Dufrayne F, Bergman G. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda[J]. Gastrointest Endosc, 2000; 52(3):346-352.
11. Chia YW, Cheng LC, Goh PM, Ngoi SS, Isaac J, Chan ST, Ti TK. Role of oral sodium phosphate and its effectiveness in large bowel preparation for out-patient colonoscopy[J]. J R Coll Surg Edinb, 1995; 40(6):374-376.
12. Ell C, Fischbach W, Keller R, Dehe M, Mayer G, Schneider B, Albrecht U, Schuette W; Hintertux Study Group. A randomized, blinded, prospective trial to compare the safety and efficacy of three bowel-cleansing solutions for colonoscopy (HSG-01*)[J]. Endoscopy, 2003; 35(4):300-304.
13. Frommer D. Cleansing ability and tolerance of three bowel preparations for colonoscopy[J]. Dis Colon Rectum, 1997; 40(1):100-104.
14. Lapalus MG, Gaudin JL, Lemkecher T, Souquet JC, Wendehenne F, Peltrault C, Pontette F, Pillon M, Monier JM, Dumont O. Prospective randomized single-blind trial comparing oral sodium phosphate with polyethylene glycol for colonoscopy preparation[J]. Gastroenterol Clin Biol, 2001;25(1): 29-34.
15. Lee J, McCallion K, Acheson AG, Irwin ST. A prospective randomised study comparing polyethylene glycol and sodium phosphate bowel cleansing solutions for colonoscopy[J]. Ulster Med J, 1999; 68(2):68-72.
16. Martinek J, Hess J, Delarive J, Jornod P, Blum A, Pantoflickova D, Fischer M, Dorta G. Cisapride does not improve precolonoscopy bowel preparation with either sodium phosphate or polyethylene glycol electrolyte lavage[J]. Gastrointest Endosc, 2001; 54(2):180-185.
17. Marshall JB, Barthel JS, King PD. Short report: prospective, randomized trial comparing a single dose sodium phosphate regimen with PEG-electrolyte lavage for colonoscopy preparation[J]. Aliment Pharmacol Ther, 1993; 7(6):679-682.
18. Seinela L, Pehkonen E, Laasanen T, Ahvenainen J. Bowel preparation for colonoscopy in very old patients: a randomized prospective trial comparing oral sodium phosphate and polyethylene glycol electrolyte lavage solution[J]. Scand J Gastroenterol, 2003;38(2):216-220.
19. Da Silva MM, Briars GL, Patrick MK, Cleghorn GJ, Shepherd RW. Colonoscopy preparation in children: safety, efficacy, and tolerance of high-versus low-volume cleansing methods[J]. J Pediatr Gastroenterol Nutr, 1997; 24(1):33-37.
20. Thomson A, Naidoo P, Crotty B. Bowel preparation for colonoscopy: a randomized prospective trail comparing sodium phosphate and polyethylene glycol in a predominantly elderly population[J]. J Gastroenterol Hepatol, 1996; 11(2):103-107.
21. Zwas FR, Cirillo NW, el-Serag HB, Eisen RN. Colonic mucosal abnormalities associated with oral sodium phosphate solution[J]. Gastrointest Endosc, 1996; 43(5):463-466.
22. Ouyang Qin, Gan Huatian, Cheng Lizhong. The effective and tolerance of oral sodium phosphate for colonoscopic preparation[J]. Chinese Digestive Jounal, 1998; 15(5):278-280.

Chinese Journal of Evidence-Based Medicine

Oral Sodium Phosphate versus Polyethylene Glycol-electrolyte Lavage Solution for Colonoscopy Preparation: A Systematic Review

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