MiraLAX Is Not as Effective as GoLytely in Bowel Cleansing Before Screening Colonoscopies

Background & Aims

Successful colonoscopies require good bowel preparations—poor bowel preparations can increase medical costs, rates of missed lesions, and procedure duration. The combination of polyethylene glycol (PEG) 3350 without electrolytes (MiraLAX; Schering-Plough Healthcare Products, Inc, Kenilworth, NJ) and 64 oz of Gatorade (PepsiCo, Inc, Purchase, NY) has gained popularity as a bowel preparation regimen. However, the efficacy and tolerability of this approach has not been compared with standard bowel preparations in clinical trials. We compared split-dose (PEG) 3350 with electrolytes (GoLytely; Braintree Laboratories, Inc, Braintree, MA) with split-dose MiraLAX alone and in combination with pretreatment medications (bisacodyl or lubiprostone) to determine the efficacy and patient tolerability of MiraLAX as an agent for bowel preparation.

Methods

We performed a prospective, randomized, blinded, controlled trial at a tertiary care center. Patients (n = 403) were randomly assigned to groups given GoLytely, MiraLAX, MiraLAX with bisacodyl (10 mg), or MiraLAX with lubiprostone (24 μg). MiraLAX was combined with 64 oz of Gatorade. All patients were surveyed regarding preparation satisfaction and tolerability. The Ottawa bowel preparation scale was used to grade colon cleanliness.

Results

GoLytely was more effective at bowel cleansing (average Ottawa score, 5.1) than MiraLAX alone (average Ottawa score, 6.9) or in combination with lubiprostone (average Ottawa score, 6.8), or bisacodyl (average Ottawa score, 6.3) (P < .001). MiraLAX was associated with a trend toward longer procedure duration (P = .096). Groups given MiraLAX rated the overall experience as more satisfactory than those given GoLytely (P < .001). There were no differences between polyp detection rates (P = .346) or adverse events (P = .823).

Conclusions

Split-dose MiraLAX in 64 oz of Gatorade is not as effective as 4 L split-dose GoLytely in bowel cleansing for screening colonoscopies.

Keywords: Colon Cancer Screening, Colon Preparation, Colorectal Neoplasia, Cathartics

Abbreviations used in this paper: BMI, body mass index, PEG, polyethylene glycol