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Artigos Originais • Rev. Col. Bras. Cir. 26 (6) • Dez 1999 • https://doi.org/10.1590/S0100-69911999000600007   copiar

Estudo prospectivo e randomizado comparando solução de fosfato de sódio oral e manitol para o preparo de cólon para colonoscopia

Mechanical bowel preparation with oral sodium phosphate solution for colonoscopy. A new small volume solution compared to the traditional mannitol

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumos

Realizamos um estudo prospectivo e randomizado comparando a utilização do fosfato de sódio oral e manitol como preparo para colonoscopia. Apresentamos a introdução do fosfato de sódio, em uma das formas nacionais (Fleet Enema), para utilização por via oral. Entre abril de 1996 e abril de 1998, 220 pacientes foram prospectivamente randomizados. A tolerância para ambos os preparos foi similar em relação à maioria dos sintomas estudados, com exceção de sensação de plenitude, cólica ou dor abdominal que ocorreram em maior freqüência com o uso de manitol. A única desvantagem em relação ao fosfato oral foi a má tolerância quanto ao sabor (p=O,O043). A avaliação do endoscopista julgou o preparo como excelente ou bom em 84% dos pacientes que fizeram uso de fosfato de sódio e em 78% dos que tomaram manitol (p=0,76, n.s.), porém o exame foi interrompido por preparo inadequado em oito e em cinco pacientes que fizeram uso de manitol e fosfato de sódio, respectivamente (p=0,56). Não ocorreram, nesta série, lesões iatrogênicas ou morbidade relacionadas com o método ou a sedação. Embora não tenham ocorrido diferenças estatisticamente significantes em relação à qualidade de ambos os preparos, o fosfato de sódio foi o de melhor tolerância, de uma maneira geral, com um número menor de efeitos colaterais.

Colonoscopia; Preparo colônico; Fosfato de sódio; Manitol

The aim of this study was to compare the cleansing ability, patient compliance, and safety of two oral solutions or colonoscopy. All eligible patients were prospectively randomized to receive either a standard mannitol solution or a 260 ml 01 sodium phosphate for bowel preparation for colonoscopy. Parameters evaluated included patient's tolerance or taste and volume 01 solutions, gastrointestinal and cardiac side effects and quality 01 preparation. Exclusion criteria included pregnancy, ascites, symptomatic congestive heart disease and pre-existent renal disease. Statistical analysis was performed using the Wilcoxón 's rank-sum test and Fisher 's exact test. Between April 96 and 98, 220 patients were prospectively randomized to receive either mannitol or sodium phosphate solutions, and completed all phases 01 the trial. Patient's tolerance for both solutions was similar except for abdominal pain and bloating, that were more common with oral mannitol. Conversely, patients tolerance to sodium phosphate was poor due to oral taste (p=0.0043). The quality of preparation was similar for both solutions. However the exam was interrupted in 8 and 5 patients who took mannitol and sodium phosphate, respectively (p =0.56) There was no morbidity or mortality in this series. Although quality of both preparations was similar; oral sodium phosphate was better tolerated overall. Both oral solutions proved to be effective and safe. Sodium phosphate was related to less dehydration and overall cost. In addition, patient tolerance of the smaller volume of sodium phosphate may be a clear advantage over the traditional mannitol.

Colonoscopy; Bowel preparation; Sodium phosphate; Mannitol

ARTIGOS ORIGINAIS

Estudo prospectivo e randomizado comparando solução de fosfato de sódio oral e manitol para o preparo de cólon para colonoscopia

Mechanical bowel preparation with oral sodium phosphate solution for colonoscopy. A new small volume solution compared to the traditional mannitol

Lúcia Câmara Castro Oliveira, TCBC-RJI; Ana Maria Zuccaro, ACBC-RJII

IChefe do Serviço de Coloproctologia do Hospital Mario Kroeff. Responsável pelo Setor de Fisiologia Anorretal do Serviço de Fisiologia Digestiva - Policlínica Geral do Rio de Janeiro. Fellow do Departamento de Cirurgia Colorretal- Cleveland Clinic Florida - TSBCP

IIChefe do Serviço de Endoscopia Digestiva do Hospital Geral de Ipanema. Chefe do Serviço de Endoscopia e Responsável pelo Setor de Fisiologia Digestiva Alta do Serviço de Fisiologia Digestiva da Policlínica Geral do Rio de Janeiro. Mestre em Gastroenterologia

Endereço para correspondência Endereço para correspondência: Dra. Lúcia Câmara Castro Oliveira Rua Visconde de Pirajá, 414/913 22.410-002 - Rio de Janeiro - RJ E-mail: lucia@UNINET.com.br

RESUMO

Realizamos um estudo prospectivo e randomizado comparando a utilização do fosfato de sódio oral e manitol como preparo para colonoscopia. Apresentamos a introdução do fosfato de sódio, em uma das formas nacionais (Fleet Enema), para utilização por via oral. Entre abril de 1996 e abril de 1998, 220 pacientes foram prospectivamente randomizados. A tolerância para ambos os preparos foi similar em relação à maioria dos sintomas estudados, com exceção de sensação de plenitude, cólica ou dor abdominal que ocorreram em maior freqüência com o uso de manitol. A única desvantagem em relação ao fosfato oral foi a má tolerância quanto ao sabor (p=O,O043). A avaliação do endoscopista julgou o preparo como excelente ou bom em 84% dos pacientes que fizeram uso de fosfato de sódio e em 78% dos que tomaram manitol (p=0,76, n.s.), porém o exame foi interrompido por preparo inadequado em oito e em cinco pacientes que fizeram uso de manitol e fosfato de sódio, respectivamente (p=0,56). Não ocorreram, nesta série, lesões iatrogênicas ou morbidade relacionadas com o método ou a sedação. Embora não tenham ocorrido diferenças estatisticamente significantes em relação à qualidade de ambos os preparos, o fosfato de sódio foi o de melhor tolerância, de uma maneira geral, com um número menor de efeitos colaterais.

Unitermos: Colonoscopia; Preparo colônico; Fosfato de sódio; Manitol.

ABSTRACT

The aim of this study was to compare the cleansing ability, patient compliance, and safety of two oral solutions or colonoscopy. All eligible patients were prospectively randomized to receive either a standard mannitol solution or a 260 ml 01 sodium phosphate for bowel preparation for colonoscopy. Parameters evaluated included patient's tolerance or taste and volume 01 solutions, gastrointestinal and cardiac side effects and quality 01 preparation. Exclusion criteria included pregnancy, ascites, symptomatic congestive heart disease and pre-existent renal disease. Statistical analysis was performed using the Wilcoxón 's rank-sum test and Fisher 's exact test. Between April 96 and 98, 220 patients were prospectively randomized to receive either mannitol or sodium phosphate solutions, and completed all phases 01 the trial. Patient's tolerance for both solutions was similar except for abdominal pain and bloating, that were more common with oral mannitol. Conversely, patients tolerance to sodium phosphate was poor due to oral taste (p=0.0043). The quality of preparation was similar for both solutions. However the exam was interrupted in 8 and 5 patients who took mannitol and sodium phosphate, respectively (p =0.56) There was no morbidity or mortality in this series. Although quality of both preparations was similar; oral sodium phosphate was better tolerated overall. Both oral solutions proved to be effective and safe. Sodium phosphate was related to less dehydration and overall cost. In addition, patient tolerance of the smaller volume of sodium phosphate may be a clear advantage over the traditional mannitol.

Key words: Colonoscopy; Bowel preparation; Sodium phosphate; Mannitol.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

REFERÊNCIAS

1. Zuccaro AM, Oliveira LCC. Rastreamento do câncer colorretal. JAMA-Gastro 1997; 5:7-14.

2. Bond JH – Suveillance after colonoscopy polipectomy: Assessing each patient's risk. Gastrointest Clin North Am 1993; 3:683.

3. Wolff BG, Beart Jr RW, Dozois RR, et al. A new bowel preparation for elective colon and rectal surgery. Arch Surg 1988;123:895-900.

4. Vanner SJ, MacDonald PH, Paterson WG, et al. A randomised prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation for colonoscopy. Am 1 Gastroenterol1989; 83:422-7.

5. Kolts BE, Lyles WE, Achem SR, et al. A comparation of lhe effectiveness and patient tolerance of oral sodium phosphate, castor oil, and standard electrolyte lavage for colonoscopy or sigmoidoscopy preparation. Am 1 Gastroenterol 1993;88:1218-23.

6. Afridi AS, Barthel JS, King PD, et al. - Prospective, randomised trial comparing a new sodium phosphate-bisacodyl regimen with a conventional PEG-ES lavage for outpatient colonoscopy preparation. Gastrointest Endoscopy 1995 ;41 :485-9.

7. Golub RW, Kerner BA, Wise WE Jr, et al. Colonoscopic bowel preparations – wich one? A brinded, prospective, randomized trial. Dis Colon Rectum 1995; 38:594-9.

8. Oliveira LCC, Wexner SD, Daniel N, et al. Mechanical bowel preparation for elective colorectal surgery. A prospective randomized trial comparing sodium phosphate and polyethylene glycol-bared oral solutions. Dis Colon Rectum 1997;40:585-591.

9. Cohen SM, Wexner SD, Binderow SR, et al. Prospective, randomised, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods. Dis Colon Rectum 1994;37:689-96.

10. Bigard MA, Gaucher P, Lassalle C - Fatal colonic explosion during colonoscopic polypectomy. Gastroenterol1979; 77:1.307-1.310.

11. KeefeeEB -Colonoscopy preps: what's best? Gastrointest Endosc 1996; 43:524-527.

12. William CB , Waye JD - Colonoscopy and flexible sigmoidoscopy. In: Yamada T, A1pers DH, Owyang C, Powwel DW, Silverstein FE - Textbook of Gastroenterology. JB Lippincott Company. Second Edition, Philadelphia, 1995, 2.571-2.589.

13. Davies GR, Santa Ana CA, Morawski SG, et al. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterol 1980;78:991-995.

14. Afridi AS, Barthel JS, King PH, et al. Prospective, randomized trial comparing a new sodium phosphate-bisacodyl regimen outpatient colonoscopy preparation. Gastrointest Endosc 1995,41:485-489.

15. Di Palma JÁ, Brady CE 111- Colon cleasing for diagnostic and surgical procedures: polyethylene glycol-electrolyte lavage solutions. Am J Gastroenterol 1989;84:1.008-1.016.

16. Vanner SI, Mac Donald PH, Paterson WG, 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 GastroenterolI990;85:422-427.

17. BeckDE, Fazio VW, Jagelman DJ -Comparison oforal lavage methodos for preoperative colonic cleansing. Dis Colon Rectum 1986;29: 699-703.

18. Lazzaroni M & Bianchi Porra G - Premedication, preparation and surveillance. Endoscopy 1999;31:2-8.

19. Habr-Gama A, Kiss DR, Araújo SEA, et al. Preparo intestinal para a cirurgia colorretal eletiva: polipetilenoglicol (PEG) X fosfato de sódio (FS) - Resultados de estudo prospectivo e randomizado. Rev Bras Coloproct 1998;18:85-89.

20. Lieberrnan DA, GhormIey J, Flora K - Effect of pral sodium phosphate colon preparation on serum electrolytes in patients with normal serum creatinine. Gastrointest Endosc 1996;43:467-469.

21. Clarkston WK, Tsen TN, Dies DF, et al- Oral sodium phosphate versus glycol electrolyte lavage solution in outpatient preparation for colonoscopy: a prospective comparison. Gastrointest Endosc 1996; 43:42-48.

22. Gupta SC, Gopalswany N, Sarkar A, et al - Cardiac arrhythmias and electrocardiographic changes during upper and lower endoscopy. Mil Med 1990;155:9-11.

23. Benjamin SB - Complications of conscious sedation. Gastrointest Endosc Cl N Am 1996;6:277-286.

24. Hixon LJ - Colorectal ulcers associated with sodium phosphate catharsis. Gastrointest Endosc 1995;42:101-102.

25, Zwas FR, Cirillo NW, EI-Serag RB, et al. Colonic mucosal abnormalities associated with phosphate solution. Gastrointest Endosc 1996; 43:463-6.

26. Faigel DO, Furth EE, Bachwich DR - Aphtoid lesions of the rectum. Letter. Gastrointest Endosc 1996;43:528-9.

27. Henderson JM, Barnett JL, Turgeon DK, et al. Single-day, divided dose oral sodium phosphate laxative versus intestinal lavage as preparation for colonoscopy: efficacy and patient tolerance. Gastrointest Endosc 1995;42:238-41.

Recebido em 22/4/99

Aceito para publicação em 14/10/99

Trabalho realizado nos Serviços de Endoscopia Digestiva da Policlínica Geral do Rio de Janeiro e Coloproctologia do Hospital Mário Kroeff.

  • 1. Zuccaro AM, Oliveira LCC. Rastreamento do câncer colorretal. JAMA-Gastro 1997; 5:7-14.
  • 2. Bond JH Suveillance after colonoscopy polipectomy: Assessing each patient's risk. Gastrointest Clin North Am 1993; 3:683.
  • 3. Wolff BG, Beart Jr RW, Dozois RR, et al. A new bowel preparation for elective colon and rectal surgery. Arch Surg 1988;123:895-900.
  • 4. Vanner SJ, MacDonald PH, Paterson WG, et al. A randomised prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation for colonoscopy. Am 1 Gastroenterol1989; 83:422-7.
  • 5. Kolts BE, Lyles WE, Achem SR, et al. A comparation of lhe effectiveness and patient tolerance of oral sodium phosphate, castor oil, and standard electrolyte lavage for colonoscopy or sigmoidoscopy preparation. Am 1 Gastroenterol 1993;88:1218-23.
  • 6. Afridi AS, Barthel JS, King PD, et al. - Prospective, randomised trial comparing a new sodium phosphate-bisacodyl regimen with a conventional PEG-ES lavage for outpatient colonoscopy preparation. Gastrointest Endoscopy 1995 ;41 :485-9.
  • 7. Golub RW, Kerner BA, Wise WE Jr, et al. Colonoscopic bowel preparations wich one? A brinded, prospective, randomized trial. Dis Colon Rectum 1995; 38:594-9.
  • 8. Oliveira LCC, Wexner SD, Daniel N, et al. Mechanical bowel preparation for elective colorectal surgery. A prospective randomized trial comparing sodium phosphate and polyethylene glycol-bared oral solutions. Dis Colon Rectum 1997;40:585-591.
  • 9. Cohen SM, Wexner SD, Binderow SR, et al. Prospective, randomised, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods. Dis Colon Rectum 1994;37:689-96.
  • 10. Bigard MA, Gaucher P, Lassalle C - Fatal colonic explosion during colonoscopic polypectomy. Gastroenterol1979; 77:1.307-1.310.
  • 11. KeefeeEB -Colonoscopy preps: what's best? Gastrointest Endosc 1996; 43:524-527.
  • 12. William CB , Waye JD - Colonoscopy and flexible sigmoidoscopy. In: Yamada T, A1pers DH, Owyang C, Powwel DW, Silverstein FE - Textbook of Gastroenterology. JB Lippincott Company. Second Edition, Philadelphia, 1995, 2.571-2.589.
  • 13. Davies GR, Santa Ana CA, Morawski SG, et al. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterol 1980;78:991-995.
  • 14. Afridi AS, Barthel JS, King PH, et al.  Prospective, randomized trial comparing a new sodium phosphate-bisacodyl regimen outpatient colonoscopy preparation. Gastrointest Endosc 1995,41:485-489.
  • 15. Di Palma JÁ, Brady CE 111- Colon cleasing for diagnostic and surgical procedures: polyethylene glycol-electrolyte lavage solutions. Am J Gastroenterol 1989;84:1.008-1.016.
  • 16. Vanner SI, Mac Donald PH, Paterson WG, 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 GastroenterolI990;85:422-427.
  • 17. BeckDE, Fazio VW, Jagelman DJ -Comparison oforal lavage methodos for preoperative colonic cleansing. Dis Colon Rectum 1986;29: 699-703.
  • 18. Lazzaroni M & Bianchi Porra G - Premedication, preparation and surveillance. Endoscopy 1999;31:2-8.
  • 19. Habr-Gama A, Kiss DR, Araújo SEA, et al. Preparo intestinal para a cirurgia colorretal eletiva: polipetilenoglicol (PEG) X fosfato de sódio (FS) - Resultados de estudo prospectivo e randomizado. Rev Bras Coloproct 1998;18:85-89.
  • 20. Lieberrnan DA, GhormIey J, Flora K - Effect of pral sodium phosphate colon preparation on serum electrolytes in patients with normal serum creatinine. Gastrointest Endosc 1996;43:467-469.
  • 21. Clarkston WK, Tsen TN, Dies DF, et al- Oral sodium phosphate versus glycol electrolyte lavage solution in outpatient preparation for colonoscopy: a prospective comparison. Gastrointest Endosc 1996; 43:42-48.
  • 22. Gupta SC, Gopalswany N, Sarkar A, et al - Cardiac arrhythmias and electrocardiographic changes during upper and lower endoscopy. Mil Med 1990;155:9-11.
  • 23. Benjamin SB - Complications of conscious sedation. Gastrointest Endosc Cl N Am 1996;6:277-286.
  • 24. Hixon LJ - Colorectal ulcers associated with sodium phosphate catharsis. Gastrointest Endosc 1995;42:101-102.
  • 25, Zwas FR, Cirillo NW, EI-Serag RB, et al. Colonic mucosal abnormalities associated with phosphate solution. Gastrointest Endosc 1996; 43:463-6.
  • 26. Faigel DO, Furth EE, Bachwich DR - Aphtoid lesions of the rectum. Letter. Gastrointest Endosc 1996;43:528-9.
  • 27. Henderson JM, Barnett JL, Turgeon DK, et al. Single-day, divided dose oral sodium phosphate laxative versus intestinal lavage as preparation for colonoscopy: efficacy and patient tolerance. Gastrointest Endosc 1995;42:238-41.

  • Endereço para correspondência:

    Dra. Lúcia Câmara Castro Oliveira
    Rua Visconde de Pirajá, 414/913
    22.410-002 - Rio de Janeiro - RJ
    E-mail:

    • Datas de Publicação

    • Publicação nesta coleção
      24 Nov 2009
    • Data do Fascículo
      Dez 1999

    Histórico

    • Recebido
      22 Abr 1999
    • Aceito
      14 Out 1999
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