A Prospective Trial Comparing Polyethylene Glycol with Sodium Phosphate in the Bowel Preparation for Surgery

수술 전 장세척제로서 Polyethylene Glycol 용액과 Sodium Phosphate 용액의 전향적 비교 분석

A Prospective Trial Comparing Polyethylene Glycol with Sodium Phosphate in the Bowel Preparation for Surgery

Seung Hyun Lee, M.D., Byung Kwon Ahn, M.D. and Sung Uhn Baek, M.D.

Purpose: Mechanical bowel preparation aims to eliminate solid stool in the colon prior to colonoscopy and colorectal surgery. During colorectal surgery, a clean bowel has advantages such as a lower bacterial load, reduced chance of spillage of fecal content, and easiery handling of the bowel. The aim of this prospective trial was to compare polyethylene glycol (PEG) and sodium phosphate solutions for colorectal surgery according to patient's tolerance, side effects, cleansing quality, and postoperative complication.

Methods: Eighty patients prospectively received either a standard 4 liter PEG solution or a 90 ml oral sodium phosphate solution. Patient's tolerance for solution was assessed with a detailed questionnaire. Before and after bowel preparation, we checked the patient's body weight, blood pressure, pulse, and biochemical parameters such as hematocrit, serum electrolyte, blood urea nitrogen, and creatinine levels. The cleansing quality was checked by the surgeon during the operation. Statistical analysis was performed using the chi-square test for patient's tolerance, body weight, blood pressure, pulse, and postoperative complication and using the paired t-test for biochemical parameters with SPSS 11.0 version.

Results: The PEG and sodium phosphate solutions were each administered to 40 patients, separately. Thirty-seven patients (92.5%) had colorectal cancer in each group. The

other underlying diseases were benign tumor, multiple polyps, diverticulitis, and familiar adenomatous polyposis. In comparing tolerance, there was no significant difference in the rate of patients who complained of difficulty on the questionnaire for discomfort (P=0.954), nor in the rate of patients who complained of severe subjective symptoms such as nausea, vomiting, abdominal pain, dizziness and sleep loss. The cleansing quality, body weight, blood pres- sure, pulse change and postoperative complication rates were not significantly different. In the PEG group, hematocrit (P=0.008), serum magnesium (P=0.03), phosphorus (P=

0.004), and blood urea nitrogen (P=0.001) were decreased and serum chloride (P=0.001) was increased. In the sodium phosphate group, serum sodium (P=0.001) was increased and serum potassium (P=0.018) was decreased. There was no significant changes in serum calcium (P=0.086) and phosphate (P=0.191) in the sodium phosphate group.

Conclusion: In both groups, there was no significant dif- ference in patient's tolerance, cleansing quality and post- operative complication rate. Though there were some bio- chemical changes between the two groups, they were not significant clinically. Therefore, the sodium phosphate solu- tion can be substituted for the PEG solution in preoperative bowel preparation. (J Korean Surg Soc 2004;66:205-211) Key Words: Preoperative bowel preparation, Polyethylene

glycol, Sodium phosphate

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Department of Surgery, College of Medicine, Kosin Uni-

versity, Busan, Korea