Background/Aims: An unsuccessful colonoscopy procedure is often related to inadequate bowel cleansing. It is difficult for patients to finish the whole 4 liters of polyethylene glycol-electrolyte lavage (PEG-EL) because of its salty taste and the large quantity. Pineapple juice has been shown to be an effective agent in the dissolution of undigested food in the stomach. This study assessed the effectiveness of both 2 and 4 liters of PEG-EL in precolonoscopic bowel cleansing and the quality of colonoscopic cleaning by adding 1 liter of pineapple juice to a reduced-volume PEG-based regime. Methods: The patients were chosen from those undergoing a colonoscopic procedure. A total of 126 patients were randomized into 3 groups receiving 3 different PEG-EL (Golytely®) regimes, i.e. 4 liters of PEG-EL (group 1, n = 44), 2 liters of PEG-EL (group 2, n = 39) or 2 liters of PEG-EL with 1 liter of pineapple juice (Dimes® 100%; group 3, n = 43). Results: Both the 4- and 2-liter PEG-EL regimes resulted in similar bowel cleansing scores in all parts of the colonic segments. However, adding 1 liter of pineapple juice to the reduced-volume PEG-EL regime improved the quality of the cleansing on the right side of the colon and in the transverse colon. Adequate bowel cleansing was achieved in 68.1% of the patients in group 1, 63.9% in group 2 and 80% in group 3 (the lowest score in one of the segments). On the other hand, the tolerability of the regimes was similar in all 3 groups (p = 0.509). Conclusions: Reduced PEG-EL (2 rather than 4 liters) may be sufficient for precolonoscopic bowel cleansing in the Turkish population. Administration of pineapple juice in the reduced-dose preparation regime may improve the quality of the bowel cleaning.

1.
Froehlich F, Wietlisbach V, Gonvers JJ, et al: Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc 2005;61:378-384.
2.
Thomson A, Naidoo P, Crotty B: Bowel preparation for colonoscopy: a randomized prospective trial comparing sodium phosphate and polyethylene glycol in a predominantly elderly population. J Gastroenterol Hepatol 1996;11:103-107.
3.
Afridi SA, Barthel JS, King PD, et al: Prospective, randomized trial comparing a new sodium phosphate-bisacodyl regimen with conventional PEG-ES lavage for outpatient colonoscopy preparation. Gastrointest Endosc 1995;41:485-489.
4.
Kolts BE, Lyles WE, Achem SR, et al: A comparison of the effectiveness and patient tolerance of oral sodium phosphate, castor oil, and standard electrolyte lavage for colonoscopy or sigmoidoscopy preparation. Am J Gastroenterol 1993;88:1218-1223.
5.
Vanner SJ, MacDonald PH, Paterson WE, et al: A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy. Am J Gastroenterol 1990;85:422-427.
6.
Lieberman DA, Ghormley J, Flora K: Effect of oral sodium phosphate colon preparation on serum electrolytes in patients with normal serum creatinine. Gastrointest Endosc 1996;43:467-469.
7.
Jansen SV, Goedhard JG, Winkens B, van Deursen CT: Preparation before colonoscopy: a randomized controlled trial comparing different regimes. Eur J Gastroenterol Hepatol 2011;23:897-902.
8.
Ell C, Fischbach W, Keller R, et al; Hintertux Study Group: A randomized, blinded, prospective trial to compare the safety and efficacy of three bowel-cleansing solutions for colonoscopy (HSG-01*). Endoscopy 2003;35:300-304.
9.
Abut E, Guveli H, Yasar B, et al: Administration of olive oil followed by a low volume of polyethylene glycol-electrolyte lavage solution improves patient satisfaction with right-side colonic cleansing over administration of the conventional volume of polyethylene glycol-electrolyte lavage solution for colonoscopy preparation. Gastrointest Endosc 2009;70:515-521.
10.
Di Palma JA, Rodriguez R, McGowan J, Cleveland MB: A randomized clinical study evaluating the safety and efficacy of a new, reduced-volume, oral sulfate colon-cleansing preparation for colonoscopy. Am J Gastroenterol 2009;104:2275-2284.
11.
Martínek J, Hess J, Delarive J, et al: Cisapride does not improve precolonoscopy bowel preparation with either sodium phosphate or polyethylene glycol electrolyte lavage. Gastrointest Endosc 2001;54:180-185.
12.
Beyazit Y, Koklu S, Ozturk ZA, et al: Inclusion of a spasmolytic in bowel cleansing: a prospective randomized study. Gastroenterol Nurs 2011;34:352-355.
13.
Sharma VK, Chockalingham SK, Ugheoke EA, et al: Prospective, randomized, controlled comparison of the use of polyethylene glycol electrolyte lavage solution in four-liter versus two-liter volumes and pretreatment with either magnesium citrate or bisacodyl for colonoscopy preparation. Gastrointest Endosc 1998;47:167-171.
14.
Poon CM, Lee DW, Mak SK, et al: Two liters of polyethylene glycol-electrolyte lavage solution versus sodium phosphate as bowel cleansing regimen for colonoscopy: a prospective randomized controlled trial. Endoscopy 2002;34:560-563.
15.
Ell C, Fischbach W, Bronisch HJ, et al: Randomized trial of low-volume PEG solution versus standard PEG + electrolytes for bowel cleansing before colonoscopy. Am J Gastroenterol 2008;103:883-893.
16.
Feffer JL, Norton RA: Dissolution of phytobezoar using pineapple juice (letter). JAMA 1976;236:1578.
17.
Simsek Z, Altinbas A, Yuksel I, Yuksel O: Effective treatment with pineapple juice in small bowel obstruction due to phytobezoar in a gastrectomized patient. Dig Endosc 2011;23:197.
18.
Altınbas A, Ekiz F, Yılmaz B, Basar O, Yuksel O: Dissolution of undigested food in a diabetic patient's stomach by drinking pineapple juice. Endocr Pract 2011;17:522-523.
19.
Rostom A, Jolicoeur E: Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc 2004;59:482-486.
20.
Yakut M, Cinar K, Seven G, et al: The efficacy and safety of colonoscopy preparation with oral sodium phosphate in elderly patients. Turk J Gastroenterol 2010;21:140-145.
21.
El Sayed AM, Kanafani ZA, Mourad FH, et al: A randomized single-blind trial of whole versus split-dose polyethylene glycol-electrolyte solution for colonoscopy preparation. Gastrointest Endosc 2003;58:36-40.
22.
Pontone S, Angelini R, Standoli M, et al: Low-volume plus ascorbic acid vs high-volume plus simethicone bowel preparation before colonoscopy. World J Gastroenterol 2011;17:4689-4695.
23.
Aronchick CA, Lipshutz WH, Wright SH, et al: A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. Gastrointest Endosc 2000;52:346-352.
24.
Hassan C, Bretthauer M, Kaminski MF, et al: Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013;45:142-150.
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