Efficacy and Patient Tolerability of Split-Dose Sodium Picosulfate/Magnesium Citrate (SPMC) Oral Solution Compared to the Polyethylene Glycol (PEG) Solution for Bowel Preparation in Outpatient Colonoscopy: An Evidence-Based Review

Antonio Afonso de Miranda Neto,1 Diogo Turiani Hourneaux de Moura,1,2 Kelly E Hathorn,2 Francisco Tustumi,3 Eduardo Guimarães Hourneaux de Moura,1 Igor Braga Ribeiro1 1Gastrointestinal Endoscopy Unit, Hospital Das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil; 2Division of Gasteoenterology, Hepatology and Endoscopy – Brigham and Women´s Hospital – Harvard Medical School, Boston, MA, USA; 3Gastrointestinal Surgery Unit, Hospital Das Clínicas, University of São Paulo School of Medicine, São Paulo, BrazilCorrespondence: Igor Braga RibeiroGastrointestinal Endoscopy Unit, Hospital Das Clínicas, University of São Paulo School of Medicine, São Paulo, BrazilTel +5592981377788Email igorbraga1@gmail.comBackground: Colonoscopy is the gold standard exam for evaluation of colonic abnormalities and for screening and surveillance for colorectal cancer. However, the efficacy of colonoscopy is dependent on the quality of the pre-colonoscopy bowel preparation. Polyethylene glycol (PEG) and sodium picosulfate/magnesium citrate (SPMC) have emerged as two of the most commonly used bowel preparation agents. We conducted an evidence-based review of current evidence to further investigate the efficacy and patient tolerability of split-dose SPMC oral solution compared to PEG solution for colonoscopy bowel preparation.Methods: A systematic search was performed using Pubmed (MEDLINE), Web of Science, EMBASE, and Cochran Central Register of Controlled Trials databases. All studies on split-dose bowel preparation with SPMC and PEG were reviewed. Relevant studies regarding colonoscopy and bowel preparations were also included. Randomized controlled trials were prioritized due to the high quality of evidence.Results: Eight randomized controlled trials were included. Split-dose SPMC and PEG were associated with similar results for adequacy of bowel preparation. Split-dose SPMC was associated with increased patient tolerability and compliance.Conclusion: Split-dose SPMC and PEG are both adequate and safe for bowel preparation for outpatient colonoscopy, with split-dose SPMC being more tolerable for patients. Additional RCTs comparing these and other bowel preparation solutions are necessary to further investigate quality of bowel preparation, patient preference, and cost-effectiveness of the various options.Keywords: colonoscopy, bowel, polyethylene, glycol, sodium, picosulfate, magnesium, citrate, PEG, SPMC, tolerability, adenoma