A single, self-administered phosphate enema is a more acceptable and more effective method of preparing the bowel for flexible sigmoidoscopy than oral Picolax, a study has found.
Ms Wendy Atkin (deputy director, Imperial Cancer Research Fund colorectal cancer unit, St Mark's hospital, Harrow) and colleagues say that the examination time was shorter with the enema and that a greater proportion of examinations were judged to be complete.
The single blind, randomised trial compared a single sachet of oral Picolax with a self administered phosphate enema (Fletchers' long tube phosphate enema) in 1,442 patients aged 55 to 64.
Compliance was higher for the enema (84 per cent) than for Picolax (79 per cent). Of those patients using the enema at home (one hour before leaving home for the sigmoidoscopy), 78 per cent found it easy to use, 15 per cent found it quite difficult and 2 per cent either found it very difficult or needed it to be administered by someone else. While taking Picolax was not a problem, the diet restrictions accompanying treatment were problematic, the study found. Following administration of Picolax, 12 hours before the sigmoidoscopy, patients were asked not to eat solid food. Twenty-five per cent of patients found this difficult to cope with, 8 per cent very difficult and 2 per cent of patients could not manage and ate something.
Fifteen per cent felt unwell after using the enema compared with 7 per cent of the Picolax group. The authors suggest that this could be because the enema takes minutes to work rather than hours for Picolax. Overall, Picolax caused more adverse effects. Wind, incontinence and sleep disturbances were reported more frequently for Picolax and bottom soreness more frequently for the enema.
Endoscopists assessed the quality of bowel preparation as excellent for 57 per cent of the enema group and 39 per cent of the Picolax group. Mean visibility of the mucosa was also better with the enema, the researchers say (British Medical Journal 2000;320:1504).