| Objective： Adequate bowel cleaning is essential for a high-quality,effective, and safe colonoscopy. Poor bowel preparations can increase medicalcosts, rates of missed lesions, and procedure duration. The ideal colonpreparation would rapidly and reliably clean the colon of fecal material whilehaving no effect on the gross or microscopic appearance of the colon. It wouldcause no discomfort, and produce no significant fluid or electrolyte shifts.Currently, the available preparation regimens fulfill some but not all of thesecriteria. Presently, the most commonly used adult colonoscopy preparationsworldwide are polyethylene glycol electrolyte (PEG) and oral sodiumphosphate (NaP) regimens. Compared with PEG,NaP has a higher risk ofdeveloping fluid or electrolyte shifts even causing acute renal failure.The2-Lpolyethylene glycol (PEG) lavage solutions in combination with prokineticagents provide efficacy similar to that of standard4-L PEG formulations inspite of the reduced volume. Mosapride citrate is clinically one of the mostused prokinetic agents. To evaluate the efficacy and acceptability of prokineticagent, mosapride citrate when given in addition to PEG on quality of colonicpreparation, polyps detection rates, adverse side effects experienced and thechange of electrolytes.Methods：In this prospective trial,104patients (aged between18and75years, with normal serum electrolyte level) were randomized to receivepreparation of PEG or PEG in combination with mosapride citrate(10mg) withdiet restriction the day before colonoscopy. Gastroenterologists performingcolonoscopies were blinded to the type of preparation. Efficacy in bowelcleansing was assessed using the Boston Bowel Preparation Scale (BPPS).The size, morphology and location of all polyps encountered during eachcolonoscopy were documented. The patient's tolerability was assessed using a patient questionnaire. Prior to and after the bowel cleansing, blood wassampled for electrolytes.Results：Four patients were rejected from the study.A total of100patients(51patients in mosapride citrate group and49patients in PEG group)completed the study and were included in the analysis. Caecal intubation wasachieved in the100procedures.No significant differences in demographicvariables(age, gender, indications and outcomes of colonoscopy)wereobserved between the two groups.1Efficacy of bowel preparationThe primary end point of our study (rate of adaquate equivalent BBPSscore≥6) was achieved by80%of mosapride group compared with47%ofthose randomized to PEG (P<0.05). Median total BBPS score of mosapridegroup was also significantly higher than that of PEG [6(IQR7-6) vs5(IQR6-4), P<0.05].2Secondary characteristicsThe times (mean,s.d.) for colonoscope intubation8.1min (4.3) vs8.7min(3.6)(P>0.05) was comparable for mosapride group and PEG grouprespectively. The times of defecate (mean,s.d.)was greater with mosapridegroup7.8times(2.5) than PEG group6.8times(2.1)(P<0.05).The time of firstdefecation (mean,s.d.) was shorten with mosapride group34.3min (24) thanPEG group45min (27.9)(P<0.05).3Polyp detection ratesPolyps were detected in8patients (16%) receiving mosapride comparedwith4patients (8.2%) in PEG group (P>0.05). Either polyps (≤10mm) orpolyps (>10mm) were found with similar frequency in both groups (12%vs8%,4%vs0%, respectively). Numerically more right colon polyps werefound in mosapride group (59%) compared with PEG group (20%), althoughthis difference did not achieve statistical significance (P>0.05).4Side effectsOn the term of tolerability, nausea, vomiting, abdominal pain, abdominaldistension were the adverse events reported. Of all the adverse events, nausea and vomiting were more frequently found in the PEG group than in mosapridegroup (53%vs29.4%,22.4%vs7.8%, P=0.016,P=0.041,respectively); butabdominal pain, bloating were not statistically significant (P=0.582,P=0.372,respectively). No serious adverse events were reported in this study.5ElectrolyteSignificant decreases in serum potassium, sodium were seen in patientstaking mosapride group.In patients on PEG group significant decreases inpotassium were observed. The baseline mean serum potassium level in themosapride and PEG groups was3.98±0.47, and4.06±0.50mmol/L, whichdecreased to3.84±0.53and3.83±0.45mmol/L, respectively. The baselinemean sodium in the mosapride group was139.7±3.37mmol/l, which decreasedto138.2±4.38mmol/l.When the proportional changes were compared between the twocleansing solutions, the proportional changes were similar between the twogroups (P>0.05)In the PEG group, hypocalcaemia developed in51%, hypokalemia in18.4%, hyponatremia in14.3%, while in the mosapride group,35.3%,17.6%15.7%, respectively.6There was no difference in patient tolerability (P>0.05).Conclusion：1Addition of mosapride to polyethylene glycol electrolyte solution duringcolonoscopy preparation improve quality of colonic preparation and decreasethe side effects.2The relationship with bowel preparation and polyps detection rates is notclear, need further research. |
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