Bowel Cleansing Effectiveness of Sulfate-Based Tablet Versus Sulfate-Based Solution for Outpatient Colonoscopy: A Retrospective Noninferiority Study.

Abstract

Background: Bowel preparation quality is one of the most important quality measures in colonoscopy. Sulfate-based tablets (Sodium sulfate, magnesium sulfate, potassium chloride) and sulfate-based solution (sodium, magnesium, potassium sulfate) are commonly used for bowel preparation for colonoscopy. However, there has been no comparison between these two.

Aims: To compare the bowel preparation quality and colonoscopy quality metrics between sulfate-based tablet sand solution, both given as a split-dose.

Methods: A retrospective, cross-sectional study in an outpatient endoscopy suite. Patients who chose sulfate-based tablet or solution were included in this study. Boston bowel preparation scale (BBPS) was used for measurement of bowel preparation quality. Primary endpoint is defined as adequate bowel preparation (any segment score ≥ 2). Secondary endpoints included total BBPS score, adenoma detection rate (ADR), withdrawal time, and cecal intubation rate. A noninferiority test was conducted.

Results: A total of 517 patients were included (161 in sulfate-based tablet and 356 in sulfate-based solution group). Sulfate-based tablet resulted in more adequate bowel preparation as compared to sulfate-based solution (98.1 vs. 93.8%; p = 0.044). Total BBPS score was 7.14 ± 1.03 and 7.04 ± 1.22 in tablet and solution groups, respectively (p = 0.366). ADR (37.2 vs. 40.3%; p = 0.681), cecal intubation rate, and withdrawal time were not statistically different between groups.

Conclusions: Split-dose sulfate-based tablet is noninferior to split-dose sulfate-based solution in bowel cleansing for colonoscopy. Sulfate tablets may lead to more adequate bowel preparation as compared to sulfate solution likely due to better tolerance. There was no significant difference in colonoscopy quality metric measures between sulfate-based tablet and solution.