대장내시경 전처치에서 4 L Polyethyleneglycol 단독투여와 45 mL Sodium Phosphate/2 L Polyethyleneglycol 병합투여의 비교: 전향적 무작위 대조 연구
Comparison of 4 L of PEG Versus Combination of 2 L of PEG and 45 mL of Sodium Phosphate for Colonoscopy Colon Cleansing: A Prospective Randomized Trial
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목적: 대장내시경 전처치로 흔히 사용되는 4 L PEG 정결액은 등장성의 전해질 용액으로 안정성이 확립되어 오래 전부터 널리 쓰이고 있으나 복용량이 많아 환자의 순응도가 떨어지는 단점이 있고, sodium phosphate (NaP) 정결액은 복용량이 적어 환자 순응도는 높으나 전해질 이상을 유발할 수 있는 문제점이 제기되어 왔다. 이에 저자들은 순응도를 높이면서 전해질 이상의 위험성을 줄일 수 있는 방법의 하나로 두 정결액의 병합투여에 대하여 연구하였다. 대상 및 방법: 2004년 6월 28일부터 2004년 8월 18일까지 고려대학교병원에 입원한 환자 중 대장내시경을 시행 받은 41명의 환자를 대상으로 전향적 무작위 대조 연구를 시행하였다. 대장 전처치는 4 L PEG 단독투여(n=21) 또는 45 mL NaP/2 L PEG 병합투여로(n=20) 실시하였으며, 양 군 간의 환자순응도, 대장내시경 정결의 정도 및 대장내시경 전후의 검사실 소견이상 유무를 비교하였다. 결과: 전체적인 불편감은 병합투여군에서 단독투여군에 비해 유의하게 낮았다(p=0.035). 병합투여군에 비해 PEG 단독투여군에서 복부 팽만감(p=0.076) 및 오심(p=0.087)을 더 호소하였으나 통계적으로 유의하지는 않았다. 대장의 정결도는 양 군 간에 의미 있는 차이는 관찰되지 않았다. 병합투여군에서 인(phosphorus)이 PEG 단독 투여군에 비해서 의미 있게 상승하였으나 임상적으로 의미가 있지는 않았다(p=0.020). 결론: NaP 45 mL와 PEG 2 L의 병합투여는 기존의 PEG 4 L 단독 투여에 비해서 전반적으로 불편감이 감소되었고 대장정결도는 유사하며 심각한 전해질 불균형을 유발하지 않았다. 따라서 향후 PEG 4 L의 투여가 곤란한 환자의 대장 정결 방법으로 PEG 2 L/NaP 45 mL의 병합투여가 하나의 대안이 될 수 있을 것으로 생각한다.
Abstract
Background/Aims: Polyethyleneglycol (PEG) is safe but its large volume and bad taste reduces patients' compliance. Sodium phosphate (NaP) is a hyperosmotic agent and its small volume can increase patients' compliance but electrolyte imbalance is a problem. Therefore, we conducted a study to determine whether patients' compliance can be enhanced and electrolyte imbalance reduced by combining these two agents. Methods: Forty-one admitted patients receiving colonoscopy at Korea University Hospital from June 28, 2004 to August 14, 2004 were randomly divided into two groups for colon cleansing with either PEG 4 L (n=21) or PEG 2 L plus NaP 45 mL (n=20). Patients were assessed for patient tolerance, quality of preparation, and changes of biochemical parameters. Results: Overall discomfort was statistically lower in the combination group, PEG 2 L plus NaP 45 mL (p=0.035). Although patients in the combination group reported less fullness (p=0.076) and nausea (p=0.087), the findings were not statistically significant. The quality of the preparation was comparable between the two groups (p=0.872). The phosphorus level in the combination group showed a statistically significant increase (0.58 0.46) after colon cleansing (p=0.020) but was not clinically significant. Conclusions: The combination of NaP 45 mL and PEG 2 L showed less overall discomfort with comparable quality of preparation and without serious electrolyte abnormality compared to 4 L of PEG. Therefore, the combination of NaP 45 mL and PEG 2 L could be used as an alternative colonoscopic colon cleansing agent when patients have trouble taking 4 L of PEG alone.
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