Single‐day sodium picosulfate and magnesium citrate versus split‐dose polyethylene glycol for bowel cleansing prior to colonoscopy: A prospective randomized endoscopist‐blinded trial

Background and Aim The intake of polyethylene glycol ( PEG ) prior colonoscopy is frequently associated with nausea and abdominal discomfort. The aim of this study was to investigate whether sodium picosulfate and magnesium citrate ( PMC ) is superior to a polyethylene glycol ( PEG ) preparation in regard to patient acceptance. Furthermore, it investigates possible differences in efficiency and patient safety. Methods In a randomised, prospective, and endoscopist‐blinded study patients were 1:1 randomized to either use PMC or 4‐ L PEG in order to prepare for colonoscopy. Cleansing regimes consisted of a split‐dose administration in the PEG arm and standard administration in the PMC arm. Primary end point was proportion of patients evaluating the bowel preparation procedure as “very distressing,” defined as ≥ 8 points on a 10‐point numeric rating scale ( NRS ). Secondary end points were quality of bowel preparation and electrolyte parameters. Results PMC bowel‐cleansing procedure was better tolerated compared with PEG ( PMC NRS<8  = 89.9% vs PEG NRS<8  = 79.2%, P  = 0.037). Mean declines in serum sodium (ΔSodium PEG  = −0.76 ± 3.07 vs ΔSodium PMC  = −3.38 ± 3.56 mmol/L; P  < 0.001), chloride (ΔChloride PEG  = −1.00 ± 3.22 vs ΔChloride PMC  = −3.49 ± 3.51 mmol/L; P  < 0.001), and osmolality (ΔOsmolality PEG  = −4.23 ± 6.82 vs ΔOsmolality PMC  = −8.83 ± 7.43 mosmol/kg; P  < 0.001) were higher in the PMC arm than in the PEG arm. Hyponatremia after bowel preparation occurred more often in PMC (21.2%) than in PEG (4.0%) ( P  < 0.001). Successful preparation was achieved more frequently in the PEG arm (42.9% vs 82.2%; P  < 0.001). Conclusion Standard picosulfate/magnesium citrate is better accepted than a split‐dose PEG regimen. From the perspective of successful preparation and patients' safety, PEG is superior to PMC .