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Updated: Apr 29, 2026
E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
A randomized, controlled trial of oral sulfate solution plus polyethylene glycol as a bowel preparation for
Douglas K Rex1, John McGowan2, Mark vB Cleveland2
1Department of Medicine, Division of Gastroenterology, Indiana University Health, Indianapolis, Indiana, USA.
Background:
No bowel preparation for colonoscopy is optimal with regard to efficacy, safety, and tolerability. New options for bowel preparation are needed.
Objective:
To compare a new hybrid preparation consisting of a reduced dose of oral sulfate solution (OSS) plus 2 L of sulfate-free electrolyte lavage solution (SF-ELS) with 2 low-volume preparations based on polyethylene glycol electrolyte lavage solution (PEG-ELS).
Design:
Two randomized, controlled trials.
Setting:
Twenty-four U.S. centers.
Patients:
A total of 737 outpatients undergoing colonoscopy.
Interventions:
In study 1, OSS plus SF-ELS was given as a split dose, and in study 2, OSS plus SF-ELS was given in its entirety the evening before colonoscopy. In study 1, the active control was 2 L of PEG-ELS plus ascorbic acid (PEG-EA) given as a split dose. In study 2, the control was 10 mg of bisacodyl plus 2 L of SF-ELS taken the evening before colonoscopy.
Main Outcome Measurements:
Rates of successful (good or excellent) bowel preparation.
Results:
In study 1, the rates of successful (excellent or good) preparation with OSS plus SF-ELS and PEG-EA were identical at 93.5% for split-dose preparation. OSS plus SF-ELS was noninferior to PEG-EA (P < .001). In study 2, OSS plus SF-ELS resulted in successful preparation in 89.8% of patients compared with 83.5% with bisacodyl plus SF-ELS in a same-day preparation regimen. OSS plus SF-ELS was noninferior to bisacodyl plus SF-ELS (P <.001). In study 1, vomiting was more frequent with OSS plus SF-ELS (13.5% vs 6.7%; P = .042), and bloating was rated worse with PEG-EA (P = .025). In study 2, overall discomfort was rated worse with OSS plus SF-ELS (mean score 2.1 vs 1.8; P = .032). There were no deaths in either study and no serious adverse events considered related to the preparation.
Limitations:
Bowel cleansing was not scored by colon segment. Adenoma detection was not compared between the regimens.
Conclusion:
OSS plus SF-ELS is a new, safe, and effective bowel preparation for colonoscopy.
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