An investigator-blinded randomized controlled prospective study comparing efficacy, tolerability, and safety of two bowel preparations in the community setting: miralax versus peg electrolyte lavage solution (PEG-ELS)

Introduction: Although not FDA approved, Miralax (PEG 3350) mixed with Gatorade is a frequently used colonoscopy bowel preparation There is conflicting data regarding its efficacy and tolerability, and limited data on its safety We aimed to compare the efficacy, tolerability and safety of Miralax with Gatorade and PEG‐ELS (polyethylene glycol electrolyte lavage solution) in the community setting Methods: Patients undergoing elective screening colonoscopy were randomized to receive either splitdosed Miralax or PEG‐ELS Serum electrolytes, calcium, and phosphorus were determined before and after the preparation Patients completed a Likert scaled questionnaire (1 = strongly agree; 5 = strongly disagree) evaluating their experience with the preparation just before colonoscopy Quality of preparation was scored by blinded endoscopists using the Boston Bowel Preparation Scale (BBPS) Results: Sixty seven patients received either Miralax (N=38) or PEG‐ELS (N=29) The groups were comparable regarding age, sex, and raceThere was no significant difference in efficacy between the Miralax and PEG‐ELS groups, with mean total BBPS scores of 734 and 782, respectively (p=153) There was no significant difference in the ability to complete at least 75% of the preparation between the groups, but more patients were willing to retake (291 vs 404; p=008) and/or recommend (285 vs 411; p=003) their Miralax preparation in the future The Miralax group also found the amount of preparation (279 vs 419, p=001) and its taste (263 vs 44, p < 001) more acceptable and their preparation to be more tolerable (274 vs 426, p < 001) The Miralax group experienced less headache than the PEG‐ELS group (292 vs 401, p=003) but there was otherwise no significant difference in side effects Finally, there was no significant difference in serum electrolytes before and after taking the preparations in either group Conclusion: Both split‐dosed preparations are effective at colon cleansing without adverse changes in serum electrolytes However, patients in the Miralax group found their preparation to be more tolerable than those in the PEG‐ELS group Additionally, more patients were in favor of using or recommending Miralax again in the future This study adds to the growing body of data regarding bowel preparation regimens and supports the effectiveness and safety of Miralax in preparing the bowel for colonoscopy with improved patient acceptance and tolerability.