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Published on: October 16, 2013
MiraLAX is not as effective as GoLytely in bowel cleansing before screening colonoscopies
Michael Hjelkrem1, Joel Stengel, Mark Liu
1Department of Medicine, Division of Gastroenterology, Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA. mhjelkrem@yahoo.com
Background & Aims:
Successful colonoscopies require good bowel preparations-poor bowel preparations can increase medical costs, rates of missed lesions, and procedure duration. The combination of polyethylene glycol (PEG) 3350 without electrolytes (MiraLAX; Schering-Plough Healthcare Products, Inc, Kenilworth, NJ) and 64 oz of Gatorade (PepsiCo, Inc, Purchase, NY) has gained popularity as a bowel preparation regimen. However, the efficacy and tolerability of this approach has not been compared with standard bowel preparations in clinical trials. We compared split-dose (PEG) 3350 with electrolytes (GoLytely; Braintree Laboratories, Inc, Braintree, MA) with split-dose MiraLAX alone and in combination with pretreatment medications (bisacodyl or lubiprostone) to determine the efficacy and patient tolerability of MiraLAX as an agent for bowel preparation.
Methods:
We performed a prospective, randomized, blinded, controlled trial at a tertiary care center. Patients (n=403) were randomly assigned to groups given GoLytely, MiraLAX, MiraLAX with bisacodyl (10 mg), or MiraLAX with lubiprostone (24 μg). MiraLAX was combined with 64 oz of Gatorade. All patients were surveyed regarding preparation satisfaction and tolerability. The Ottawa bowel preparation scale was used to grade colon cleanliness.
Results:
GoLytely was more effective at bowel cleansing (average Ottawa score, 5.1) than MiraLAX alone (average Ottawa score, 6.9) or in combination with lubiprostone (average Ottawa score, 6.8), or bisacodyl (average Ottawa score, 6.3) (P<.001). MiraLAX was associated with a trend toward longer procedure duration (P=.096). Groups given MiraLAX rated the overall experience as more satisfactory than those given GoLytely (P<.001). There were no differences between polyp detection rates (P=.346) or adverse events (P=.823).
Conclusions:
Split-dose MiraLAX in 64 oz of Gatorade is not as effective as 4 L split-dose GoLytely in bowel cleansing for screening colonoscopies.
Insights
Polyethylene glycol (PEG) 3350 with Gatorade (MiraLAX) is less effective for colonoscopy bowel preparation than standard GoLytely. Patients found MiraLAX more satisfactory, but it did not improve polyp detection or reduce adverse events.
Area of Science:
- Gastroenterology
- Clinical Trials
- Medical Devices & Equipment
Background:
- Effective bowel preparation is crucial for successful colonoscopies, impacting costs, lesion detection, and procedure length.
- Polyethylene glycol (PEG) 3350 without electrolytes (MiraLAX) combined with Gatorade is a popular, yet unproven, bowel preparation method.
- Standard bowel preparations like GoLytely are well-established but can be less tolerable for patients.
Purpose of the Study:
- To compare the efficacy and patient tolerability of MiraLAX-based bowel preparations against standard split-dose GoLytely.
- To evaluate MiraLAX alone and in combination with bisacodyl or lubiprostone for colon cleansing.
- To determine if MiraLAX offers a more satisfactory patient experience without compromising colon cleanliness.
Main Methods:
- A prospective, randomized, blinded, controlled trial involving 403 patients.
- Patients were assigned to receive either GoLytely, MiraLAX alone, MiraLAX with bisacodyl, or MiraLAX with lubiprostone.
- Colon cleanliness was assessed using the Ottawa bowel preparation scale, and patient satisfaction/tolerability were surveyed.
Main Results:
- GoLytely demonstrated superior bowel cleansing efficacy (lower Ottawa scores) compared to MiraLAX alone or with adjuncts (P<.001).
- Patients reported higher overall satisfaction with MiraLAX-based preparations compared to GoLytely (P<.001).
- No significant differences were observed in polyp detection rates or adverse events across the groups.
Conclusions:
- Split-dose MiraLAX with Gatorade is less effective for bowel cleansing in screening colonoscopies than split-dose GoLytely.
- While MiraLAX may improve patient satisfaction, its reduced efficacy impacts colon cleanliness.
- Further research may explore optimizing MiraLAX regimens or identifying patient populations where its use is appropriate.
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