Efficacy and Patient Tolerability of Split-Dose Sodium Picosulfate/Magnesium Citrate (SPMC) Oral Solution Compared to the Polyethylene Glycol (PEG) Solution for Bowel Preparation in Outpatient Colonoscopy: An Evidence-Based Review

Figures & data

Figure 1 Flow chart for study selection.

Table 1 Characteristics of the Studies Included in the Review

Authors (Publication Year)	Study Design	N	Country	Gender (N)	Age Range	Solution Regimen	Score Bowel Preparation Quality	Results (Best Tolerability)
Rostom et al, 2019^Citation19	Prospective, randomized, single-center	141	Canada	PEG: 36 (female)/SPMC: 34 (female)	PEG: 56.4/SPMC: 57.6	Split-dose SPMC and PEG lavage into 1-day split or 2-day split	OBPS	-
Mathus-Viegen et al, 2018^Citation21	Noninferiority, randomized, single-center	341	Netherlands	PEG-Asc+B: 84 (female)/SPMC: 88 (female)	PEG-Asc+B: 58.5/SPMC: 55.5	SPMC and PEG-Asc+B split-dose	OBPS	SPMC
Seo et al, 2018^Citation22	Prospective, randomized, single-center	223	Germany	2-L-PEG/Asc: 52 (male)/SPMC: 65 (male)	2-L-PEG/Asc: 56.1/SPMC: 54.9	2-L-PEG/Asc and SPMC split-dose	Aronchick and OBPS	SPMC
Kojecky et al, 2017^Citation20	Prospective, randomized, multi-center	973	Czech Republic	-	-	PEG, SPMC and PEGA in a single or a split-dose	Aronchick	SPMC
Kim et al, 2015^Citation26	Prospective, randomized, multi-center	365	South Korea	SPMC/bisacodyl: 94 (male)/4-L PEG: 100 (male)	SPMC/bisacodyl: 53.5 (male)/4-L PEG: 53.8 (male)	Split preparation SPMC/bisacodyl and conventional (4-L) split PEG	BBPS	SPMC/bisacodyl
Yoo et al, 2015^Citation23	Prospective, randomized, single-center	200	South Korea	SPMC: 46 (male)/PEG-Asc: 53 (male)	SPMC: 53.27/PEG-Asc: 56.97	Split-dose methods of SPMC and PEG-Asc	BBPS and Aronchick	SPMC
Jeon et al, 2015^Citation24	Prospective, randomized, single-center	388	South Korea	2-L-PEG/Asc: 108 (male)/SPMC: 109 (male)	2-L-PEG/Asc: 54.7/SPMC: 53.6	2-L-PEG/Asc and three sachets of SPMC, both in split-dose	BBPS	Similar tolerability
Manes et al, 2013^Citation25	Prospective, randomized, multi-center	285	Italy	1-L-PEG+Asc: 85 (male)/SPMC: 76 (male)	1-L-PEG+Asc: 57.8/SPMC: 60.9	Split-dose methods of 1-L-PEG+Asc and one sachet of SPMC	BBPS	SPMC

Abbreviations: PEG, polyethylene glycol; SPMC, sodium picosulfate/magnesium citrate; PEG-Asc+B, polyethylene glycol + ascorbic acid + bisacodyl; 2-L-PEG/Asc, 2 liters polyethylene glycol + ascorbic acid; 1-L-PEG/Asc, 1 liter polyethylene glycol + ascorbic acid; OBPS, Ottawa Bowel Preparation Scale; BBPS, Boston Preparation Scale.

Table 2 Characteristics of Bowel Validated Scoring Systems

Scale Name	Score	Description	Characteristics
Aronchick Scale	1	Excellent: small volume of liquid; >95% of mucosa seen.	Total score range: Minimum 1 (excellent) to maximum 5 (inadequate). Score performed before washing or suctioning. No separate ratings for segments; global colon rating only.
	2	Good: clear liquid covering 525% of mucosa, but >90% of mucosa seen.
	3	Fair: semisolid stool could not be suctioned or washed away, but >90% of mucosa seen.
	4	Poor: semisolid stool could not be suctioned or washed away and <90% of mucosa seen.
	5	Inadequate: repeat preparation/screening needed.
Ottawa Bowel Preparation Scale (by Colon Segment)	0	Excellent: mucosal detail clearly visible, almost no stool residue; if fluid present, it is clear, almost no stool residue.	Total score (obtained by adding scores for each segment + total colon fluid score) range: Minimum 0 (excellent) to maximum 14 (inadequate). Scoring performed before washing or suctioning. Rates cleansing by colon segment: Right colon, mid-colon, and rectosigmoid colon.
	1	Good: some turbid fluid or stool residue, but mucosal detail still visible without need for washing/suctioning.
	2	Fair: Some turbid fluid of stool residue obscuring mucosal detail; however, mucosal detail becomes visible with suctioning, washing not needed.
	3	Poor: Stool present obscuring mucosal detail and contour; a reasonable view is obtained with suctioning and washing.
	4	Inadequate: Solid stool obscuring mucosal detail and not cleared with washing and suctioning.
Boston Bowel Preparation Scale (by Colon Segment)	0	Unprepared colon segment with mucosa not seen because of solid stool that cannot be cleared.	Total score (obtained by adding scores for each segment) range: Minimum 0 (very poor) to maximum 9 (excellent). Scoring performed after washing or suctioning. Segments separately rated: Right colon (including cecum and ascending colon); transverse (includes hepatic and splenic flexures); and left colon (descending and sigmoid colon, and rectum).Threshold optimally is total score of ≥6 AND ≥2 per segment.
	1	Portion of mucosa of the colon segment seen, but other areas of segment not well seen because of staining, residual stool, and/or opaque liquid.
	2	Minor amount of residual staining, small fragments of stool, and/or opaque liquid, but mucosa of colon segment is well seen.
	3	Entire mucosa of colon segment well seen, with no residual staining, small fragments of stool, or opaque liquid.

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