Oral sodium phosphate (Fleet) is a superior colonoscopy preparation to Picopre (sodium picosulfate-based preparation).

Purpose: Small-volume bowel preparation is better tolerated than 4-liter polyethylene glycol lavage. However, the efficacy of various small-volume bowel preparation agents for colonoscopy has not been clearly defined. This randomized, controlled trial was designed to compare oral sodium phosphate (Fleet) with Picoprep (sodium picosulfate-based preparation).

Methods: Two hundred twenty-five outpatients, aged 65 years or younger, who would undergo colonoscopy by two endoscopists were randomized to receive two bottles of oral sodium phosphate or three sachets of Picoprep. A standardized questionnaire was completed by all patients and the endoscopists. The endoscopists were blinded to the preparation used.

Results: One hundred three patients were randomized to oral sodium phosphate (Fleet) (Group 1) and 122 patients to Picoprep (Group 2). Three patients were excluded because of colonic strictures. The groups were similar in age and gender, indications for colonoscopy, and previous colonic surgery. The quality of bowel cleansing in patients taking oral sodium phosphate (Fleet) was significantly better than Picoprep as assessed by the endoscopists (P = 0.0014). Both types of bowel preparation were associated with similar incidence of nausea (P = 0.4927), dizziness (P= 0.9663), abdominal cramps (P = 0.7157), and patient acceptability (P = 0.0767). Equal majority from either group would use the same bowel preparation again (91 percent of oral sodium phosphate (Fleet) and 93 percent of Picoprep group; P = 0.6172). Although Picoprep was better tasting (P = 0.0273), oral sodium phosphate (Fleet)was perceived to be a good preparation agent by a greater (although not significant) proportion of patients (P = 0.0853).

Conclusions: Oral sodium phosphate (Fleet) is more effective in bowel cleansing than Picoprep as a bowel preparation agent. Both agents have similar side effects and patient acceptance.