A Randomized Double-Blind Controlled Trial Comparing Two Forms of Enema for Flexible Sigmoidoscopy
Sakchai Ruangsin MD*, Vorapong Chowchuvech MD*
Affiliation : * Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla
Objective : To compare bowel preparation quality and patient tolerance of two common enema solutions for
flexible sigmoidoscopy.
Materials and Methods : Three hundred adults were randomized to receive a hypertonic sodium chloride or
hypertonic sodium phosphate enema regime, each consisting of two enemas administered 60 and 30 min
before the procedure. Patients completed surveys on preparation comfort. Patients and endoscopist were
blinded to the preparation used. During the procedure, the endoscopist took pictures of the mucosa and
intraluminal content. All pictures were later evaluated by a single doctor who graded the quality of the
preparation.
Results : There were no serious complications during or following the procedures. The preparation quality
was rated as excellent or good by 76.9% of the hypertonic sodium chloride group and 72.9% of the hypertonic
sodium phosphate group (p = 0.423). The hypertonic sodium chloride enema was associated with more
abdominal discomfort (p = 0.018).
Conclusion : Both enemas were safe for all patients with no statistical difference between the qualities of the
two bowel preparations. Both preparations performed their bowel-cleaning function well and were suitable
for the preparation of patients before flexible sigmoidoscopy. The less expensive hypertonic sodium chloride
solution may be an option for hospitals where budgetary considerations are important.
Keywords : Flexible sigmoidoscopy, Phosphate enema, Sodium chloride enema, Bowel preparation
