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A Randomized Clinical Trial Evaluating Mannitol, Lactitol, and Polyethylene Glycol Macrogol as Oral Solutions for Colonoscopy Preparation

Received: 11 August 2020    Accepted: 26 August 2020    Published: 23 September 2020
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Abstract

Colonoscopy is an important tool for diagnosing and treating bowel injuries and reducing colorectal cancer incidence. Adequate bowel preparation is necessary to ensure the effectiveness of the procedure for detecting injuries. In this trial the aim was to compare effectiveness of lactitol, mannitol, and polyethylene glycol (PEG) oral solutions for bowel cleansing prior to colonoscopy. This is a randomized, blinded clinical trial. The primary endpoint was to evaluate the adequacy of colon cleansing according to the Boston Bowel Preparation Scale (BBPS). A total of 294 patients were randomized into three groups. The overall adequacy of bowel cleansing was achieved in 98.8% in the mannitol, followed by 93.5% in the lactitol and 92.3% in the PEG group. When comparing lactitol and mannitol, the efficacy to bowel preparation was greater in the mannitol group, but without statistical significance (P=0.164). The adequacy to bowel preparation was slightly better in the mannitol group than PEG (98.8% vs. 92.2%, respectively), but with P-value of 0.073. In adjusted analysis, the results were similar. The frequency of hypernatremia after bowel preparation was 25.3% in the mannitol group, followed by 7.3% and 5.2% in the PEG and lactitol, respectively. Considering tolerance for bowel preparation solution there was no difference between the mannitol and lactitol groups (P=0.07); but lactitol was better tolerated when compared to PEG (P=0.001). In conclusion, mannitol, lactitol and PEG are effective as intestinal cleansing solutions before colonoscopy, but adverse events, taste and tolerability must be considered before choosing.

Published in International Journal of Gastroenterology (Volume 4, Issue 2)
DOI 10.11648/j.ijg.20200402.16
Page(s) 54-62
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Intestinal Preparation, Bowel Cleansing, Colonoscopy, Lactitol, Mannitol, Polyethylene Glycol

References
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Cite This Article
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    Lourianne Nascimento Cavalcante, Adriana Ribas, Alexandre Pithon Lins, Luciana Rodrigues Leal da Silva, Flora Maria Lorenzo Fortes, et al. (2020). A Randomized Clinical Trial Evaluating Mannitol, Lactitol, and Polyethylene Glycol Macrogol as Oral Solutions for Colonoscopy Preparation. International Journal of Gastroenterology, 4(2), 54-62. https://doi.org/10.11648/j.ijg.20200402.16

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    ACS Style

    Lourianne Nascimento Cavalcante; Adriana Ribas; Alexandre Pithon Lins; Luciana Rodrigues Leal da Silva; Flora Maria Lorenzo Fortes, et al. A Randomized Clinical Trial Evaluating Mannitol, Lactitol, and Polyethylene Glycol Macrogol as Oral Solutions for Colonoscopy Preparation. Int. J. Gastroenterol. 2020, 4(2), 54-62. doi: 10.11648/j.ijg.20200402.16

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    AMA Style

    Lourianne Nascimento Cavalcante, Adriana Ribas, Alexandre Pithon Lins, Luciana Rodrigues Leal da Silva, Flora Maria Lorenzo Fortes, et al. A Randomized Clinical Trial Evaluating Mannitol, Lactitol, and Polyethylene Glycol Macrogol as Oral Solutions for Colonoscopy Preparation. Int J Gastroenterol. 2020;4(2):54-62. doi: 10.11648/j.ijg.20200402.16

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  • @article{10.11648/j.ijg.20200402.16,
      author = {Lourianne Nascimento Cavalcante and Adriana Ribas and Alexandre Pithon Lins and Luciana Rodrigues Leal da Silva and Flora Maria Lorenzo Fortes and Valdeck Sodre Bispo Jr and Marcus Vinicius Matos de Almeida and Maira Cintra de Oliveira and Camila Silveira and Marcos Clarencio Batista and Igelmar Barreto Paes},
      title = {A Randomized Clinical Trial Evaluating Mannitol, Lactitol, and Polyethylene Glycol Macrogol as Oral Solutions for Colonoscopy Preparation},
      journal = {International Journal of Gastroenterology},
      volume = {4},
      number = {2},
      pages = {54-62},
      doi = {10.11648/j.ijg.20200402.16},
      url = {https://doi.org/10.11648/j.ijg.20200402.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijg.20200402.16},
      abstract = {Colonoscopy is an important tool for diagnosing and treating bowel injuries and reducing colorectal cancer incidence. Adequate bowel preparation is necessary to ensure the effectiveness of the procedure for detecting injuries. In this trial the aim was to compare effectiveness of lactitol, mannitol, and polyethylene glycol (PEG) oral solutions for bowel cleansing prior to colonoscopy. This is a randomized, blinded clinical trial. The primary endpoint was to evaluate the adequacy of colon cleansing according to the Boston Bowel Preparation Scale (BBPS). A total of 294 patients were randomized into three groups. The overall adequacy of bowel cleansing was achieved in 98.8% in the mannitol, followed by 93.5% in the lactitol and 92.3% in the PEG group. When comparing lactitol and mannitol, the efficacy to bowel preparation was greater in the mannitol group, but without statistical significance (P=0.164). The adequacy to bowel preparation was slightly better in the mannitol group than PEG (98.8% vs. 92.2%, respectively), but with P-value of 0.073. In adjusted analysis, the results were similar. The frequency of hypernatremia after bowel preparation was 25.3% in the mannitol group, followed by 7.3% and 5.2% in the PEG and lactitol, respectively. Considering tolerance for bowel preparation solution there was no difference between the mannitol and lactitol groups (P=0.07); but lactitol was better tolerated when compared to PEG (P=0.001). In conclusion, mannitol, lactitol and PEG are effective as intestinal cleansing solutions before colonoscopy, but adverse events, taste and tolerability must be considered before choosing.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - A Randomized Clinical Trial Evaluating Mannitol, Lactitol, and Polyethylene Glycol Macrogol as Oral Solutions for Colonoscopy Preparation
    AU  - Lourianne Nascimento Cavalcante
    AU  - Adriana Ribas
    AU  - Alexandre Pithon Lins
    AU  - Luciana Rodrigues Leal da Silva
    AU  - Flora Maria Lorenzo Fortes
    AU  - Valdeck Sodre Bispo Jr
    AU  - Marcus Vinicius Matos de Almeida
    AU  - Maira Cintra de Oliveira
    AU  - Camila Silveira
    AU  - Marcos Clarencio Batista
    AU  - Igelmar Barreto Paes
    Y1  - 2020/09/23
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ijg.20200402.16
    DO  - 10.11648/j.ijg.20200402.16
    T2  - International Journal of Gastroenterology
    JF  - International Journal of Gastroenterology
    JO  - International Journal of Gastroenterology
    SP  - 54
    EP  - 62
    PB  - Science Publishing Group
    SN  - 2640-169X
    UR  - https://doi.org/10.11648/j.ijg.20200402.16
    AB  - Colonoscopy is an important tool for diagnosing and treating bowel injuries and reducing colorectal cancer incidence. Adequate bowel preparation is necessary to ensure the effectiveness of the procedure for detecting injuries. In this trial the aim was to compare effectiveness of lactitol, mannitol, and polyethylene glycol (PEG) oral solutions for bowel cleansing prior to colonoscopy. This is a randomized, blinded clinical trial. The primary endpoint was to evaluate the adequacy of colon cleansing according to the Boston Bowel Preparation Scale (BBPS). A total of 294 patients were randomized into three groups. The overall adequacy of bowel cleansing was achieved in 98.8% in the mannitol, followed by 93.5% in the lactitol and 92.3% in the PEG group. When comparing lactitol and mannitol, the efficacy to bowel preparation was greater in the mannitol group, but without statistical significance (P=0.164). The adequacy to bowel preparation was slightly better in the mannitol group than PEG (98.8% vs. 92.2%, respectively), but with P-value of 0.073. In adjusted analysis, the results were similar. The frequency of hypernatremia after bowel preparation was 25.3% in the mannitol group, followed by 7.3% and 5.2% in the PEG and lactitol, respectively. Considering tolerance for bowel preparation solution there was no difference between the mannitol and lactitol groups (P=0.07); but lactitol was better tolerated when compared to PEG (P=0.001). In conclusion, mannitol, lactitol and PEG are effective as intestinal cleansing solutions before colonoscopy, but adverse events, taste and tolerability must be considered before choosing.
    VL  - 4
    IS  - 2
    ER  - 

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Author Information
  • Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil

  • Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil

  • Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil

  • Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil

  • Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil

  • Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil

  • Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil

  • Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil

  • Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil

  • Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil

  • Hospital Geral Roberto Santos, Digestive Endoscopy and Gastroenterology Services, Salvador, Bahia, Brazil

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