COMPARISION OF POLYETHYLENE GLYCOL AND SODIUM PHOSPHATE IN BOWEL PREPARATION FOR ELECTIVE COLORECTAL CANCER SURGERY
KEMAL DOLAY, GÜRSEL SOYBİR, GÖKHAN ADAŞ, AYTEKİN COŞKUN, ZEYNEP ALGÜN, SEFA TÜZÜN
Haseki Eğitim ve Araştırma Hastanesi 2. Cerrahi Kliniği, İSTANBUL
The aim of the study was to compare polyethylene glycol (PEG) and Na phosphate (SF) oral electrolyte solutions which were used in mechanical bowel cleansing for patients with colorectal cancer in terms of patient tolarence, side effects and efficacy using macroscopic, biochemical and histopathologic parameters. In this double blind randomized prospective clinical study which was conducted between March 1999 and September 2000, 40 patients were randomized into two groups, 4.5 L PEG solution (Transipeg 90 cachets) was used for mechanical bowel cleansing in the first group (20 patients), and 90 mL SF in the second group (20 patients). Patient tolarence pertaining to the use of the bowel cleansing solutions was sought by detailed questions. Blood samples were taken from all patients prior to and following mechanical cleansing to assess biochemical alterations. Bowel cleansing was evaluated intraoperatively by detecting whether or not the bowel contained gas, liquid, soft stool with particles or hard stool. In the bowel mucosa specimen obtained through biopsy, cript lengths, cell content of sialomusin and sulphomusin, Proliferating Cell Nüclear Antigen (PCNA) score, and morphological alterations were assessed by the pathologist. Postoperative morbidity and mortalities were recorded. There was no statistically significant difference between two groups regarding blood pH, PaO2, PaCO2, HCO3, O2 saturation, Na, K, Cl, Ca, ALT, AST, BUN, Htc, creatinin, glucose, AST and ALT prior to and following mechanical cleansing (p>0.05). There was no statistically significant difference between the two groups in terms of cripta length measurements, goblet cell counts, and morphologic changes. There was statistically significant difference in PCNA scores which is a determinant of mitotic activity in favor of the PEG group (p< 0.01). The efficacy of PEG and SF in bowel cleansing was 95% and 90%, respectively (p>0.05). Six patients (30%) in the PEG group showed full compliance, 9 patients (45%) was able to tolerate the procedure fairly easily despite some complaints, and 5 patients (25%) tolerated with difficulty. In the SF group, 17 patients (85%) showed full compliance, 3 patients (15%) was able to tolerate the procedure fairly easily despite some complaints, and there was no patients who tolerated with difficulty. This difference was statistically significant (p<0.001). There was no difference between two groups regarding morbidity, and no mortality was detected. We believe that, SF which is not different from PEG in terms of efficacy and side effects can be prefered in mechanical bowel cleansing instead of PEG which needs to be ingested in greater amounts.
Keywords: BOWEL PREPARATION, COLORECTAL CANCER, POLYETHYLENE GLYCOL, NA PHOSPHATE