A Prospective Single-Blinded Randomized Trial Comparing Colonoscopic Preparation at Different Time
Condition: Colonoscopy; Colon Neoplasm
MeSH terms: Colonic Neoplasms
Study type: Interventional

Summary: 
      Colorectal cancer (CRC) is the leading cause of cancer death not only in the Western
      countries but also in Taiwan. Colonoscopy is now gradually accepted as one of the powerful
      tool for colorectal cancer screening. Not only for survey after positive fecal test, it is
      also applied as primary screening modality for CRC screening.Colon cleansing before
      colonoscopy thus becomes critically important and inadequate preparation may lead to low
      diagnostic yield with missed lesions, increased risk of complication and prolonged procedure
      time. Though the importance of good colon preparation can not be over-emphasized, diet
      control before colonoscopy and ingestion of large amount of lavage solution remain a
      significant hurdle to overcome and investigators continue to seek for the ideal colon
      preparation with respect to quality and examinee satisfaction. After the introduction of
      polyethylene glycol electrolyte lavage solution (PEG-ELS) for bowel preparation before colon
      procedures, its safety was well documented and the efficacy of colon cleansing was proven
      efficient. The timing of ingesting PEG-ELS is different between institutes and some ingest
      PEG-ELS as a whole at the night before colonoscopic examination and some ingested in
      split-dose manner which ingest half of the solution at previous night and remaining on the
      day of examination. Some institutes ask examinee to receive lavage solution on the day of
      examination. The manufacturer advices start taking medication on the day before the
      investigation according to their printed instruction on the package of PEG-ELS. Though there
      were a lot of studies that conducted to describe the result of colon cleansing in different
      fashion, the result is still controversial. This prospective, randomized, single-blinded
      trail evaluated and compared the efficacy of colon preparation at two timing of colon
      preparation, namely, in previous night or on the day of colonoscopic examination. In this
      study, we enrolled those who have already colon neoplasia detected during voluntary routine
      health check-up and received second colonoscopic examination for either elective polypectomy
      or endoscopic mucosectomy (EMR). We used not only the cleansing condition as a reference of
      adequate preparation; we also compared the diagnostic yield of lesion number as an objective
      comparator between these two methods.
    

Detailed description: 
      Colorectal cancer (CRC) is the leading cause of cancer death not only in the Western
      countries but also in Taiwan. It is now the third leading cause of cancer mortality both in
      men and women in Taiwan. Previous studies revealed early detection of adenomatous polyp, the
      precursor lesion of CRC, plays a pivotal role in CRC prevention and removal of these lesions
      was proven to reduce CRC mortality. Fecal occult blood test (FOBT) is now the standard mass
      screening modality and colonoscopy is the standard procedure of choice if FOBT was positive.
      Nevertheless, colonoscopy is now gradually accepted as one of the powerful tool for
      colorectal cancer screening. Not only for survey after positive fecal test, it is also
      applied as primary screening modality for CRC screening.Colon cleansing before colonoscopy
      thus becomes critically important and inadequate preparation may lead to low diagnostic yield
      with missed lesions, increased risk of complication and prolonged procedure time. Though the
      importance of good colon preparation can not be over-emphasized, diet control before
      colonoscopy and ingestion of large amount of lavage solution remain a significant hurdle to
      overcome and investigators continue to seek for the ideal colon preparation with respect to
      quality and examinee satisfaction.

      After the introduction of polyethylene glycol electrolyte lavage solution (PEG-ELS) for bowel
      preparation before colon procedures, its safety was well documented and the efficacy of colon
      cleansing was proven efficient. The timing of ingesting PEG-ELS is different between
      institutes and some ingest PEG-ELS as a whole at the night before colonoscopic examination
      and some ingested in split-dose manner which ingest half of the solution at previous night
      and remaining on the day of examination. Some institutes ask examinee to receive lavage
      solution on the day of examination. The manufacturer advices start taking medication on the
      day before the investigation according to their printed instruction on the package of
      PEG-ELS. Though there were a lot of studies that conducted to describe the result of colon
      cleansing in different fashion, the result is still controversial.

      This prospective, randomized, single-blinded trail evaluated and compared the efficacy of
      colon preparation at two timing of colon preparation, namely, in previous night or on the day
      of colonoscopic examination. In this study, we enrolled those who have already colon
      neoplasia detected during voluntary routine health check-up and received second colonoscopic
      examination for either elective polypectomy or endoscopic mucosectomy (EMR). We used not only
      the cleansing condition as a reference of adequate preparation; we also compared the
      diagnostic yield of lesion number as an objective comparator between these two methods.
    

Intervention name(s): Different timing of taking polyethylene glycol(PEG)
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single
Primary purpose: Diagnostic
Keywords: Colonoscopy; Polyethylene glycol(PEG); Colon neoplasm; Colon cleansing; Timing