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Published in: Trials 1/2023

Open Access 01-12-2023 | Colonoscopy | Study protocol

Safety and efficacy comparison of polyethylene glycol, hemp seed oil, and 5% sugar brine for bowel preparation in older patients: study protocol for a randomized controlled trial

Authors: Xing Wang Zhu, Jun Yan, Long Miao, Ying Li He, Hai Ping Wang, Xun Li

Published in: Trials | Issue 1/2023

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Abstract

Background

The incidence of colorectal cancer among the middle-aged and elderly is gradually increasing in China. Colonoscopy is an effective method for the early diagnosis of colorectal cancer, and bowel preparation is one of many important factors affecting colonoscopy. Although there are many studies on intestinal cleansers, the results are not ideal. There is evidence that hemp seed oil has certain potential effects in intestinal cleansing, but prospective studies on this topic are still lacking.

Methods

This is a randomized, double-blind, single-center clinical study. We randomly assigned 690 participants to groups each administered 3 L of polyethylene glycol (PEG), 30 mL of hemp seed oil and 2 L of PEG, or 30 mL of hempseed oil, 2 L of PEG, and 1000 mL of 5% sugar brine. The Boston Bowel Preparation Scale was considered the primary outcome measure. We evaluated the interval between consumption of bowel preparation and first bowel movement. Secondary indicators included the time of cecal intubation, detection rate of polyps and adenomas, willingness to repeat the same bowel preparation, whether the protocol was tolerated, and whether there were adverse reactions during bowel preparation and were evaluated after counting the total number of bowel movements.

Discussion

This study aimed to test the hypothesis that hemp seed oil (30 mL) increases the quality of bowel preparation and reduces the amount of PEG. Previously, we found that its combination with 5% sugar brine can reduce the occurrence of adverse reactions.

Trial registration

Chinese Clinical Trial Registry ChiCTR2200057626. Prospectively registered on March 15, 2022
Appendix
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Literature
1.
go back to reference Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33.PubMedCrossRef Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33.PubMedCrossRef
2.
go back to reference Feng RM, Zong YN, Cao SM, Xu RH. Current cancer situation in China: good or bad news from the 2018 Global Cancer Statistics? Cancer Commun (Lond). 2019;39(1):22.PubMedCrossRef Feng RM, Zong YN, Cao SM, Xu RH. Current cancer situation in China: good or bad news from the 2018 Global Cancer Statistics? Cancer Commun (Lond). 2019;39(1):22.PubMedCrossRef
3.
go back to reference Buskermolen M, Cenin DR, Helsingen LM, Guyatt G, Vandvik PO, et al. Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study. BMJ. 2019;367:l5383.PubMedPubMedCentralCrossRef Buskermolen M, Cenin DR, Helsingen LM, Guyatt G, Vandvik PO, et al. Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study. BMJ. 2019;367:l5383.PubMedPubMedCentralCrossRef
4.
go back to reference Ladabaum U, Dominitz JA, Kahi C, Schoen RE. Strategies for colorectal cancer screening. Gastroenterology. 2020;158(2):418–32.PubMedCrossRef Ladabaum U, Dominitz JA, Kahi C, Schoen RE. Strategies for colorectal cancer screening. Gastroenterology. 2020;158(2):418–32.PubMedCrossRef
5.
go back to reference Cha JM, Kozarek RA, La Selva D, Gluck M, Ross A, et al. Risks and benefits of colonoscopy in patients 90 years or older, compared with younger patients. Clin Gastroenterol Hepatol. 2016;14(1):80–6 e1.PubMedCrossRef Cha JM, Kozarek RA, La Selva D, Gluck M, Ross A, et al. Risks and benefits of colonoscopy in patients 90 years or older, compared with younger patients. Clin Gastroenterol Hepatol. 2016;14(1):80–6 e1.PubMedCrossRef
6.
go back to reference Wang W, Yin P, Liu YN, Liu JM, Wang LJ, et al. Mortality and years of life lost of colorectal cancer in China, 2005-2020: findings from the national mortality surveillance system. Chin Med J. 2021;134(16):1933–40.PubMedPubMedCentralCrossRef Wang W, Yin P, Liu YN, Liu JM, Wang LJ, et al. Mortality and years of life lost of colorectal cancer in China, 2005-2020: findings from the national mortality surveillance system. Chin Med J. 2021;134(16):1933–40.PubMedPubMedCentralCrossRef
7.
go back to reference Corley DA, Jensen CD, Marks AR, Zhao WK, Lee JK, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370(14):1298–306.PubMedPubMedCentralCrossRef Corley DA, Jensen CD, Marks AR, Zhao WK, Lee JK, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370(14):1298–306.PubMedPubMedCentralCrossRef
8.
go back to reference Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687–96.PubMedPubMedCentralCrossRef Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687–96.PubMedPubMedCentralCrossRef
9.
go back to reference Song M, Emilsson L, Bozorg SR, Nguyen LH, Joshi AD, et al. Risk of colorectal cancer incidence and mortality after polypectomy: a Swedish record-linkage study. Lancet Gastroenterol Hepatol. 2020;5(6):537–47.PubMedPubMedCentralCrossRef Song M, Emilsson L, Bozorg SR, Nguyen LH, Joshi AD, et al. Risk of colorectal cancer incidence and mortality after polypectomy: a Swedish record-linkage study. Lancet Gastroenterol Hepatol. 2020;5(6):537–47.PubMedPubMedCentralCrossRef
10.
go back to reference Betesh AL, Schnoll-Sussman FH. Colorectal cancer screening in the elderly. Clin Geriatr Med. 2021;37(1):173–83.PubMedCrossRef Betesh AL, Schnoll-Sussman FH. Colorectal cancer screening in the elderly. Clin Geriatr Med. 2021;37(1):173–83.PubMedCrossRef
12.
go back to reference Guo R, Wang YJ, Liu M, Ge J, Zhang LY, et al. The effect of quality of segmental bowel preparation on adenoma detection rate. BMC Gastroenterol. 2019;19(1):119.PubMedPubMedCentralCrossRef Guo R, Wang YJ, Liu M, Ge J, Zhang LY, et al. The effect of quality of segmental bowel preparation on adenoma detection rate. BMC Gastroenterol. 2019;19(1):119.PubMedPubMedCentralCrossRef
13.
go back to reference Gardezi SA, Tibbatts C. Improving bowel preparation for colonoscopy in a cost effective manner. BMJ Qual Improv Rep. 2017;6:1–5.CrossRef Gardezi SA, Tibbatts C. Improving bowel preparation for colonoscopy in a cost effective manner. BMJ Qual Improv Rep. 2017;6:1–5.CrossRef
14.
go back to reference Choi HS, Shim CS, Kim GW, Kim JS, Lee SY, et al. Orange juice intake reduces patient discomfort and is effective for bowel cleansing with polyethylene glycol during bowel preparation. Dis Colon Rectum. 2014;57(10):1220–7.PubMedCrossRef Choi HS, Shim CS, Kim GW, Kim JS, Lee SY, et al. Orange juice intake reduces patient discomfort and is effective for bowel cleansing with polyethylene glycol during bowel preparation. Dis Colon Rectum. 2014;57(10):1220–7.PubMedCrossRef
15.
go back to reference Clark RE, Godfrey JD, Choudhary A, Ashraf I, Matteson ML, et al. Low-volume polyethylene glycol and bisacodyl for bowel preparation prior to colonoscopy: a meta-analysis. Ann Gastroenterol. 2013;26(4):319–24.PubMedPubMedCentral Clark RE, Godfrey JD, Choudhary A, Ashraf I, Matteson ML, et al. Low-volume polyethylene glycol and bisacodyl for bowel preparation prior to colonoscopy: a meta-analysis. Ann Gastroenterol. 2013;26(4):319–24.PubMedPubMedCentral
17.
go back to reference Emmanuel A, Mattace-Raso F, Neri MC, Petersen KU, Rey E, et al. Constipation in older people: a consensus statement. Int J Clin Pract. 2017;71:e12920, Emmanuel A, Mattace-Raso F, Neri MC, Petersen KU, Rey E, et al. Constipation in older people: a consensus statement. Int J Clin Pract. 2017;71:e12920,
18.
go back to reference Di Palma JA, Bhandari R, Cleveland MV, Mishkin DS, Tesoriero J, et al. A safety and efficacy comparison of a new sulfate-based tablet bowel preparation versus a PEG and ascorbate comparator in adult subjects undergoing colonoscopy. Am J Gastroenterol. 2021;116(2):319–28.PubMedCrossRef Di Palma JA, Bhandari R, Cleveland MV, Mishkin DS, Tesoriero J, et al. A safety and efficacy comparison of a new sulfate-based tablet bowel preparation versus a PEG and ascorbate comparator in adult subjects undergoing colonoscopy. Am J Gastroenterol. 2021;116(2):319–28.PubMedCrossRef
19.
go back to reference Saito Y, Oka S, Tamai N, Kudo T, Kuniyoshi N, et al. Efficacy and safety of oral sulfate solution for bowel preparation in Japanese patients undergoing colonoscopy: noninferiority-based, randomized, controlled study. Dig Endosc. 2021;33(7):1131–8.PubMedPubMedCentralCrossRef Saito Y, Oka S, Tamai N, Kudo T, Kuniyoshi N, et al. Efficacy and safety of oral sulfate solution for bowel preparation in Japanese patients undergoing colonoscopy: noninferiority-based, randomized, controlled study. Dig Endosc. 2021;33(7):1131–8.PubMedPubMedCentralCrossRef
20.
go back to reference Coskun Y, Yuksel I. Polyethylene glycol versus split high-dose senna for bowel preparation: a comparative prospective randomized study. J Gastroenterol Hepatol. 2020;35(11):1923–9.PubMedCrossRef Coskun Y, Yuksel I. Polyethylene glycol versus split high-dose senna for bowel preparation: a comparative prospective randomized study. J Gastroenterol Hepatol. 2020;35(11):1923–9.PubMedCrossRef
21.
go back to reference Zhang S, Zheng D, Wang J, Wu J, Lei P, et al. Simethicone improves bowel cleansing with low-volume polyethylene glycol: a multicenter randomized trial. Endoscopy. 2018;50(4):412–22.PubMedCrossRef Zhang S, Zheng D, Wang J, Wu J, Lei P, et al. Simethicone improves bowel cleansing with low-volume polyethylene glycol: a multicenter randomized trial. Endoscopy. 2018;50(4):412–22.PubMedCrossRef
22.
go back to reference Zhou Y, Wang S, Lou H, Fan P. Chemical constituents of hemp (Cannabis sativa L.) seed with potential anti-neuroinflammatory activity. Phytochem Lett. 2018;23:57–61.CrossRef Zhou Y, Wang S, Lou H, Fan P. Chemical constituents of hemp (Cannabis sativa L.) seed with potential anti-neuroinflammatory activity. Phytochem Lett. 2018;23:57–61.CrossRef
23.
go back to reference Yan X, Tang J, dos Santos PC, Nurisso A, Simões-Pires CA, et al. Characterization of lignanamides from hemp (Cannabis sativa L.) seed and their antioxidant and acetylcholinesterase inhibitory activities. J Agric Food Chem. 2015;63(49):10611–9.PubMedCrossRef Yan X, Tang J, dos Santos PC, Nurisso A, Simões-Pires CA, et al. Characterization of lignanamides from hemp (Cannabis sativa L.) seed and their antioxidant and acetylcholinesterase inhibitory activities. J Agric Food Chem. 2015;63(49):10611–9.PubMedCrossRef
24.
go back to reference Tsai JC, Tsai S, Chang WC. Effect of ethanol extracts of three Chinese medicinal plants with laxative properties on ion transport of the rat intestinal epithelia. Biol Pharm Bull. 2004;27(2):162–5.PubMedCrossRef Tsai JC, Tsai S, Chang WC. Effect of ethanol extracts of three Chinese medicinal plants with laxative properties on ion transport of the rat intestinal epithelia. Biol Pharm Bull. 2004;27(2):162–5.PubMedCrossRef
25.
go back to reference Li G, Guo C, Wu S, Li H, Sun J. Regulatory effects of Cannabis fructus oil on gut microecology in d-galactoseinduced aging mice. Chin Tradit Herb Drugs. 2020;51(13):3509–17 (Chinese). Li G, Guo C, Wu S, Li H, Sun J. Regulatory effects of Cannabis fructus oil on gut microecology in d-galactoseinduced aging mice. Chin Tradit Herb Drugs. 2020;51(13):3509–17 (Chinese).
26.
go back to reference Jurgoński A, Opyd PM, Fotschki B. Effects of native or partially defatted hemp seeds on hindgut function, antioxidant status and lipid metabolism in diet-induced obese rats. J Funct Foods. 2020;72:104071.CrossRef Jurgoński A, Opyd PM, Fotschki B. Effects of native or partially defatted hemp seeds on hindgut function, antioxidant status and lipid metabolism in diet-induced obese rats. J Funct Foods. 2020;72:104071.CrossRef
27.
go back to reference Cheng CW, Bian ZX, Zhu LX, Wu JC, Sung JJ. Efficacy of a Chinese herbal proprietary medicine (hemp seed pill) for functional constipation. Am J Gastroenterol. 2011;106(1):120–9.PubMedCrossRef Cheng CW, Bian ZX, Zhu LX, Wu JC, Sung JJ. Efficacy of a Chinese herbal proprietary medicine (hemp seed pill) for functional constipation. Am J Gastroenterol. 2011;106(1):120–9.PubMedCrossRef
28.
go back to reference Huang T, Ning Z, Hu D, Zhang M, Zhao L, et al. Uncovering the mechanisms of Chinese herbal medicine (Ma Zi Ren Wan) for functional constipation by focused network pharmacology approach. Front Pharmacol. 2018;9:270.PubMedPubMedCentralCrossRef Huang T, Ning Z, Hu D, Zhang M, Zhao L, et al. Uncovering the mechanisms of Chinese herbal medicine (Ma Zi Ren Wan) for functional constipation by focused network pharmacology approach. Front Pharmacol. 2018;9:270.PubMedPubMedCentralCrossRef
29.
go back to reference Zhong LLD, Cheng CW, Kun W, Dai L, Hu DD, et al. Efficacy of Ma Zi Ren Wan, a Chinese herbal medicine, in patients with functional constipation in a randomized controlled trial. Clin Gastroenterol Hepatol. 2019;17(7):1303–10 e18.PubMedCrossRef Zhong LLD, Cheng CW, Kun W, Dai L, Hu DD, et al. Efficacy of Ma Zi Ren Wan, a Chinese herbal medicine, in patients with functional constipation in a randomized controlled trial. Clin Gastroenterol Hepatol. 2019;17(7):1303–10 e18.PubMedCrossRef
30.
go back to reference Torres-Salas P, Pedrali A, Bavaro T, Ambrosini S, Marrubini G, et al. Preparation of PUFA concentrates as acylglycerols via enzymatic hydrolysis of hempseed oil (Cannabis sativa L.) in a homogeneous low-water medium. Eur J Lipid Sci Technol. 2014;116(11):1496–504.CrossRef Torres-Salas P, Pedrali A, Bavaro T, Ambrosini S, Marrubini G, et al. Preparation of PUFA concentrates as acylglycerols via enzymatic hydrolysis of hempseed oil (Cannabis sativa L.) in a homogeneous low-water medium. Eur J Lipid Sci Technol. 2014;116(11):1496–504.CrossRef
31.
32.
go back to reference Wang S, Yang Y, Hu R, Long H, Wang N, et al. Trends and associated factors of dietary knowledge among Chinese older residents: results from the China health and nutrition survey 2004-2015. Int J Environ Res Public Health. 2020;17(21):8029.PubMedPubMedCentralCrossRef Wang S, Yang Y, Hu R, Long H, Wang N, et al. Trends and associated factors of dietary knowledge among Chinese older residents: results from the China health and nutrition survey 2004-2015. Int J Environ Res Public Health. 2020;17(21):8029.PubMedPubMedCentralCrossRef
33.
go back to reference Chinello M, Scommegna S, Shardlow A, Mazzoli F, De Giovanni N, et al. Cannabinoid poisoning by hemp seed oil in a child. Pediatr Emerg Care. 2017;33(5):344–5.PubMedCrossRef Chinello M, Scommegna S, Shardlow A, Mazzoli F, De Giovanni N, et al. Cannabinoid poisoning by hemp seed oil in a child. Pediatr Emerg Care. 2017;33(5):344–5.PubMedCrossRef
34.
go back to reference Jang E, Kim H, Jang S, Lee J, Baeck S, et al. Concentrations of THC, CBD, and CBN in commercial hemp seeds and hempseed oil sold in Korea. Forensic Sci Int. 2020;306:110064.PubMedCrossRef Jang E, Kim H, Jang S, Lee J, Baeck S, et al. Concentrations of THC, CBD, and CBN in commercial hemp seeds and hempseed oil sold in Korea. Forensic Sci Int. 2020;306:110064.PubMedCrossRef
35.
go back to reference Cerne K. Toxicological properties of Δ9-tetrahydrocannabinol and cannabidiol. Arh Hig Rada Toksikol. 2020;71(1):1–11.PubMedPubMedCentral Cerne K. Toxicological properties of Δ9-tetrahydrocannabinol and cannabidiol. Arh Hig Rada Toksikol. 2020;71(1):1–11.PubMedPubMedCentral
36.
go back to reference Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586.PubMedPubMedCentralCrossRef Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586.PubMedPubMedCentralCrossRef
37.
go back to reference Tian X, Shi B, Liu XL, Chen H, Chen WQ. A randomized trial of split dose 3 L polyethylene glycol lavage solution, 2 L polyethylene glycol lavage combined with castor oil, and 1 L of polyethylene glycol lavage solution combined with castor oil and ascorbic acid for preparation for colonoscopy. Front Med (Lausanne). 2019;6:158.PubMedCrossRef Tian X, Shi B, Liu XL, Chen H, Chen WQ. A randomized trial of split dose 3 L polyethylene glycol lavage solution, 2 L polyethylene glycol lavage combined with castor oil, and 1 L of polyethylene glycol lavage solution combined with castor oil and ascorbic acid for preparation for colonoscopy. Front Med (Lausanne). 2019;6:158.PubMedCrossRef
38.
go back to reference Zhang S, Li M, Zhao Y, Lv T, Shu Q, et al. 3-L split-dose is superior to 2-L polyethylene glycol in bowel cleansing in Chinese population: a multicenter randomized, controlled trial. Medicine. 2015;94(4):e472.PubMedPubMedCentralCrossRef Zhang S, Li M, Zhao Y, Lv T, Shu Q, et al. 3-L split-dose is superior to 2-L polyethylene glycol in bowel cleansing in Chinese population: a multicenter randomized, controlled trial. Medicine. 2015;94(4):e472.PubMedPubMedCentralCrossRef
39.
go back to reference Gao Y, Lin JS, Zhang HD, Lin MX, Cheng CS, et al. Pilot validation of the Boston bowel preparation scale in China. Dig Endosc. 2013;25(2):167–73.PubMedCrossRef Gao Y, Lin JS, Zhang HD, Lin MX, Cheng CS, et al. Pilot validation of the Boston bowel preparation scale in China. Dig Endosc. 2013;25(2):167–73.PubMedCrossRef
40.
go back to reference Xia C, Dong X, Li H, Cao M, Sun D, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J. 2022;135(5):584–90.PubMedPubMedCentralCrossRef Xia C, Dong X, Li H, Cao M, Sun D, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J. 2022;135(5):584–90.PubMedPubMedCentralCrossRef
41.
go back to reference Sweetser S, Baron TH. Optimizing bowel cleansing for colonoscopy. Mayo Clin Proc. 2015;90(4):520–6.PubMedCrossRef Sweetser S, Baron TH. Optimizing bowel cleansing for colonoscopy. Mayo Clin Proc. 2015;90(4):520–6.PubMedCrossRef
42.
go back to reference Enestvedt BK, Tofani C, Laine LA, Tierney A, Fennerty MB. 4-liter split-dose polyethylene glycol is superior to other bowel preparations, based on systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2012;10(11):1225–31.PubMedCrossRef Enestvedt BK, Tofani C, Laine LA, Tierney A, Fennerty MB. 4-liter split-dose polyethylene glycol is superior to other bowel preparations, based on systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2012;10(11):1225–31.PubMedCrossRef
43.
go back to reference Sey MSL, Von Renteln D, Sultanian R, McDonald C, Bouin M, et al. A multicenter randomized controlled trial comparing two bowel cleansing regimens for colonoscopy after failed bowel preparation. Clin Gastroenterol Hepatol. 2022 Jun;20(6):e1283–91.PubMedCrossRef Sey MSL, Von Renteln D, Sultanian R, McDonald C, Bouin M, et al. A multicenter randomized controlled trial comparing two bowel cleansing regimens for colonoscopy after failed bowel preparation. Clin Gastroenterol Hepatol. 2022 Jun;20(6):e1283–91.PubMedCrossRef
44.
go back to reference Hong SN, Lee CK, Im JP, Choi CH, Byeon JS, et al. Efficacy and safety of split-dose bowel preparation with 1 L polyethylene glycol and ascorbate compared with 2 L polyethylene glycol and ascorbate in a Korean population: a phase IV, multicenter, randomized, endoscopist-blinded study. Gastrointest Endosc. 2022;95(3):500–511.e2.PubMedCrossRef Hong SN, Lee CK, Im JP, Choi CH, Byeon JS, et al. Efficacy and safety of split-dose bowel preparation with 1 L polyethylene glycol and ascorbate compared with 2 L polyethylene glycol and ascorbate in a Korean population: a phase IV, multicenter, randomized, endoscopist-blinded study. Gastrointest Endosc. 2022;95(3):500–511.e2.PubMedCrossRef
Metadata
Title
Safety and efficacy comparison of polyethylene glycol, hemp seed oil, and 5% sugar brine for bowel preparation in older patients: study protocol for a randomized controlled trial
Authors
Xing Wang Zhu
Jun Yan
Long Miao
Ying Li He
Hai Ping Wang
Xun Li
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Colonoscopy
Published in
Trials / Issue 1/2023
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-022-07059-1

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