Low-volume hybrid bowel preparation combining saline laxatives with oral contrast agents versus standard polyethylene glycol lavage for colonoscopy.

PURPOSE: The aim of this study was to compare the quality of low-volume hybrid computed tomography colonography bowel preparation, using both laxatives and oral contrast, with standard polyethylene glycol lavage.

METHODS

The study group consisted of 300 consecutive adults (mean age, 58.3 years) who underwent colonoscopy immediately after positive computed tomography colonography. Hybrid bowel preparation for study group was <1 L in total volume, consisting of osmotic cathartic (sodium phosphate or magnesium citrate) in conjunction with oral contrast (2% barium and diatrizoate). A control group of 300 adults (mean age, 58.3 years) underwent primary colonoscopy after standard 4-liter polyethylene glycol lavage without oral contrast. The prospective preparation quality rating by the endoscopist served as the reference standard. A rating of poor/marginal was considered inadequate and adequate/good/excellent was considered diagnostic.

RESULTS

The frequency of inadequate bowel preparation was 4.3% (13/300) in the study group vs 12.3% (37/300) for the control group (P < .001). Specifically, preparation was poor or marginal in 10 and 3 cases in the hybrid cohort, respectively, and in 29 and 8 cases in the polyethylene glycol cohort, respectively. Preparation quality was scored as excellent in 32% (96/300) in the hybrid cohort and 23.3% (70/300) in the polyethylene glycol cohort (P < .05).

CONCLUSIONS

At colonoscopy, low-volume laxative-oral contrast hybrid preparations are effective for bowel cleansing, perhaps even more so than polyethylene glycol lavage. Beyond improvements in quality, the low-volume preparation may improve patient compliance and would allow for immediate computed tomography colonography if colonoscopy is incomplete, without the need for additional oral contrast tagging.