#15 Keeping The Colon Clean

Study #15

This study is a direct follow-on from Study #14, reporting the results of a prospective randomized, blinded study of the effectiveness of 2 imodium tablets in preserving a clean cecum after a polyethylene glycol based bowel preparation for colonoscopy.

Church J, Bast J, Elayi E, Xhaja X. Keeping the cecum clean: a randomized, prospective, placebo-controlled trial of loperamide as part of preparation for colonoscopy. Dis Colon Rectum. 2013; 56: 120-5.

Background: Coating of the cecum with sticky bile causes a problem with inspection of the mucosa during colonoscopy.

Purpose: This study aimed to see whether 4 mg of loperamide taken after colonoscopy preparation would delay the passage of bile and improve the quality of cecal preparation.

Patients: Patients undergoing office colonoscopy were included. Patients with incomplete colonoscopies or right colectomy were excluded.

Study design: This study was a prospective, randomized, double-blinded, and placebo-controlled trial.

Intervention: Either 2 placebo capsules or 2 loperamide capsules were taken after gut lavage, as soon as the passage of liquid stool ceased. Cecal photographs were scored in a blinded fashion.

Main outcome measures: The primary outcomes measured were the quality of cecal preparation on a scale of 1 to 5 and overall preparation on a scale of 1 to 4.

Results: Ninety-eight patients took loperamide (50 men, 48 women) and 102 took placebo (57 men, 45 women). Mean ages of the loperamide group were: men, 61.9 ± 11.9 years, and women, 61.8 ± 10.0 years; and mean ages of the placebo group were: men, 62.5 ± 12.1 years, and women, 58.6 ± 9.8 years. Over 90% of patients used a polyethylene glycol-based preparation. Thirteen of 102 (12.7%) placebo cases had a dirty or coated cecum (score 4 or 5). In the loperamide group, this number was 2 of 98 (2.0%; p = 0.0041). Nineteen placebo cases (18.6%) had an overall fair/poor preparation in comparison with 9 of the loperamide group (9.2%; p = 0.0543). Days to first bowel movement were 2.4 ± 1.1 for loperamide and 2.5 ± 1.7 for placebo (p = 0.7224). Fifty-eight percent of loperamide patients had polyps, and 74% of these patients had multiple polyps; 67% of placebo patients had polyps, but only 54% of these patients had multiple polyps (vs loperamide, p = 0.0183).

Conclusion: Judicious use of loperamide can significantly improve the quality of cecal preparation and may increase polyp yield