RANDOMIZED, CONTROLLED COMPARISON OF 2 FORMS OF PREPARATION FOR SCREENING FLEXIBLE SIGMOIDOSCOPY

Objective: There is a paucity of data regarding the optimal form of bo wel preparation for flexible sigmoidoscopy. Most endoscopists recommen d enemas. A simpler preparation that is easy, acceptable, and that red uces patient encounter time would be desirable, and might be cost-effe ctive. Our objective in this study was to evaluate a simple oral form of preparation for screening flexible sigmoidoscopy. Methods: In this randomized, single-blind, controlled trial, we compared two forms of p reparation in consecutive male patients referred for screening flexibl e sigmoidoscopy. The oral preparation consisted of one bottle of magne sium citrate and two ''Dulcolax'' tablets on the evening before flexib le sigmoidoscopy. This was compared with the standard form of preparat ion, namely, two Fleet's enemas given on arrival at the endoscopy suit e. Thirty-seven patients received the oral preparation [mean age, 62.8 +/- 8.9 (SD) yr]; 33 received enemas (mean age, 65.2 +/- 7.3 yr). End oscopists were blinded to the preparation. Results: Mean time between arrival and starting flexible sigmoidoscopy was 36 +/- 22 (SD) min for patients on oral preparation, and 62 +/- 25 min for patients receivin g enemas (p < 0.0001). Mean times performing flexible signaoidoscopy w ere 10 +/- 3 min and 13 +/- 4 min, respectively (p = 0.004). Mean pati ent satisfaction score (range 0-13) was higher for patients given the oral preparation (11.4 +/- 1.8) than for patients receiving enemas (9. 6 +/- 2.4) (p = 0.001). Fifteen patients randomized to receive the ora l preparation had previous flexible sigmoidoscopy with an enema prepar ation; all preferred the oral form. Mean technical difficulty (range 1 -10) was 3 +/- 2.2 for patients given the oral preparation and 4.9 +/- 3.1 for patients receiving the enema preparation (p = 0.01). Polyps w ere identified in 10/37 patients who received the oral preparation and in 3/33 patients who received enemas (p = 0.05). Quality of colon pre paration was judged ''good'' in 29, ''fair'' in four, and ''poor'' in four, among the 37 patients given the oral form; corresponding values for 33 patients given enemas were 16, 10, and 7 (p = 0.03). Conclusion : Patient acceptance, encounter time, technical ease, and quality of c olon preparation were significantly better with the oral form of colon preparation than with the standard Fleet enema preparation.