Prospective, randomized, single-blind comparison of two preparations for screening flexible sigmoidoscopy

Background: The best and most cost-effective bowel cleansing regimen for pa tients undergoing flexible sigmoidoscopy is not known. The aim of this stud y was to compare patient tolerance, quality of preparation, and cost of 2 b owel cleansing regimens for flexible sigmoidoscopy. Methods: Two hundred fifty consecutive patients referred for screening flex ible sigmoidoscopy were randomized to receive an oral preparation (45 mL or al sodium phosphate and 10 mg bisacodyl) or an enema preparation (2 Fleet e nemas and 10 mg bisacodyl). Tolerance of the preparation was graded as easy , tolerable, slightly difficult, extremely difficult, or intolerable. The e ndoscopist was blinded to which preparation the patient received and graded the quality of the preparation as poor, fair, good, or excellent. Cost was calculated by adding the cost of the medications and the cost for the nurs ing time required to prepare the patient for endoscopy. Results: Patients in the oral preparation group were more likely to grade t he preparation as easy or tolerable when compared with the enema group (96. 8% vs. 56.4%, p < 0.001). The endoscopist graded the quality of the prepara tion as good or excellent in 86.5% of the patients in the oral preparation group compared with 57.3% in the enema group (p < 0.001). In the oral prepa ration group, the mean nursing time (34.6 vs. 65.3 minutes, p < 0.001) and cost ($16.39 vs. $31.13, p < 0.001) were significantly less than in the ene ma group. Conclusions: An oral sodium phosphate preparation results in a superior qua lity endoscopic examination that is better tolerated and more cost-effectiv e than enemas in patients undergoing screening flexible sigmoidoscopy.