1. Nicholas Michael Kelly, MRCP (UK), MB, BCH, BAO,* Colin Rodgers, FRCP,* Neil Patterson, MD,* Sudheer George Jacob, MD,* and Inder Mainie, MDw J Clin Gastroenterol 2012;00:000–000 R3. Jae-Ryung Shin/ Prof. Hyo-Jong Kim A Prospective Audit of the Efficacy, Safety, and Acceptability of Low-volume Polyethylene Glycol (2L) Versus Standard Volume Polyethylene Glycol (4L) Versus Magnesium Citrate Plus Stimulant Laxative as Bowel Preparation for Colonoscopy Journal conference 2012.05.30

2. Colorectal cancer Second most common cause of death from malignant disease in the UK The lifetime risk is 6% Colonoscopy reduces mortality from colorectal cancer in asymptomatic individuals The British Society of Gastroenterology (BSG) “Quality and Safety Indicators for Endoscopy” guidelines Quality standard – auditable outcome for example, completion rates for colonoscopy ≥ 90% bowel preparation described as excellent or adequate Introduction

3. A prospective audit of the efficacy, safety, and acceptability low-volume polyethylene glycol (2L Moviprep) vs Standard volume polyethylene glycol (4L Klean-Prep) vs Combined oral sennosides with magnesium citrate (Citramag) Polyethylene glycol : osmotic laxative, large volume, bad taste Poor patient compliance and suboptimal bowel preparation Magnesium citrate : osmotic laxative, smaller volumes Oral sennosides: stimulant laxative, increasing the force and frequency of the peristaltic contractions Introduction The aim of this study

4. PATIENTS AND METHODS Patients referred for elective colonoscopy in a single endoscopy unit Between October 2007 and February 2008 Selection of patients All patients referred to the unit for diagnostic or therapeutic colonoscopy between the ages of 18-85 years Exclusion criteria - Patients who had a previous colonoscopy and were satisfied with their last preparation regime - NYHA grade IV heart failure - CKD stage 4/5 - Known hypersensitivity or intolerance to any of the agents used

5. PATIENTS AND METHODS Treatment Regimes Large volume PEG lavage group (KleanPrep) Morning procedure - 4L of the preparation the day before Afternoon procedure – 2L the evening before 2L before their appointed procedure time Small volume PEG lavage group(Moviprep) Morning procedure - 2L of solution starting at 4 PM the day before Afternoon procedure - 1L of bowel preparation the evening before 1L before their appointment time

6. PATIENTS AND METHODS Treatment Regimes Oral senna and magnesium citrate group (Citramag) 1 sachet of senna granules at 2 PM 1 and 1/2 sachets of Citramag at 5 PM + at least 1 L of clear fluid in addition to the bowel preparation Morning procedure - 1/2 sachet of Citramag at 6 to 7 AM Afternoon procedure - 1/2 sachet of Citramag at 9 to 10 AM

7. PATIENTS AND METHODS

8. “Pass” “Fail”

9. PATIENTS AND METHODS score0 score1 score2score3 score4

10. Results Patient Demographics In total 258 (female, 138; 53.5%) patients were recruited 91 patients taking KleanPrep (female, 45; 49.5%), 86 patients took Moviprep (female, 45; 52.3%) 81 patients in the Senna/Citramag group (female, 44; 54.3%) The age range was 21 to 83 years The average age in each of the 3 groups, KleanPrep, Moviprep, and Senna/Citramag was 56.2, 57.9, and 55.4 years, respectively There were no significant differences in baseline characteristics between the 3 groups of patients

11. Results 74.4% 74.5% 86.5% A+B

12. Results

13. Mean sedation doses were similar across the 3 groups KleanPrep midazolam 3.1 mg, pethidine 38.5 mg Moviprep midazolam 3.2 mg, pethidine 38.2 mg Senna/Citramag 3.0 mg, pethidine 34.6 mg (P=not significant for all comparisons) Mean procedure times were also similar across the 3 groups KleanPrep 24.82 min, Moviprep 29.94 min, Senna/Citramag 27.00 min

14. Results

15. Low-volume PEG (Moviprep) and Senna/Citramag combination were better tolerated than large volume PEG with Senna/Citramag providing superior mucosal cleansing Conclusion