Polyethylene glycol plus bisacodyl: A safe, cheap, and effective regimen for colonoscopy in the South Asian patients

BACKGROUND AND AIM: Data regarding the comparison of colonoscopic preparation regimens are still variable. We aimed to assess the adequacy and tolerability of two bowel preparation regimens for afternoon colonoscopy. METHODS: In a randomized, investigator‐blinded trial, two preparation regimens [4‐L split‐dose polyethylene glycol‐electrolytes (PEG‐ELS) and 2‐L PEG‐ELS plus bisacodyl) were compared in terms of bowel cleansing efficacy and adverse effects. RESULTS: The mean (±SD) age (years) of the 4‐L split‐dose PEG‐ELS group (N = 147) and the 2‐L PEG‐ELS plus bisacodyl (N = 155) were 44.09 (±15.62) (M:F : 2:1) and 44.12 years (±15.61) (M:F : 1.7:1), respectively. Percentage of patients with excellent and good preparation was higher in the 4‐L split‐dose PEG‐ELS regimen compared with the 2‐L PEG‐ELS plus bisacodyl regimen (22.44 vs 17.41 and 44.21% vs 36.12%). Percentage of patients with fair and poor preparation was lower in 4‐L split‐dose PEG‐ELS regimen compared with the 2‐L PEG‐ELS plus bisacodyl regimen (21.08% vs 27.74% and 12.24% vs 18.70%). In comparison with the 2‐L PEG‐ELS plus bisacodyl group, the incidences of abdominal pain (11% vs 15%), bloating (9% vs 12.24%), nausea/vomiting (8.38% vs 9.52%), and sleep disturbance (11% vs 12%) were slightly more common in the 4‐L split‐dose PEG‐ELS group. There were no statistically significant differences between the two regimens with regard to bowel cleansing efficacy and adverse events. CONCLUSIONS: The 2‐L PEG‐ELS plus bisacodyl (10 mg) preparation is as efficacious as the 4‐L split‐dose PEG‐ELS regimen for afternoon colonoscopy. Optimal preparation for colonoscopy can be achieved with the 2‐L PEG‐ELS plus bisacodyl regimen with slightly fewer adverse events and lower cost compared to the 4‐L split‐dose PEG‐ELS regimen.