Tjandra JJ et al. (2006) Oral sodium phosphate (Fleet®) is a superior colonoscopy preparation to Picoprep® (sodium picosulfate-based preparation). Dis Colon Rectum 49: 1–6

Successful colonoscopy depends greatly on adequate preparation of the bowel. Small-volume agents are known to give better results than large-volume agents, but the small-volume agents themselves have not been directly compared. An Australian team has compared the efficacy, side-effect profile and patient acceptability of Fleet® (CB Fleet Co., Lynchburg, VA), also known as oral sodium phosphate, and Picoprep® (Pharmatel Pty Ltd, Sydney, Australia), a sodium-picosulfate-based agent.

Patients were randomly allocated to receive either two 45 ml bottles of Fleet® (n = 103) or three sachets of Picoprep® (n = 122) before colonoscopy. All patients completed a questionnaire regarding the efficacy, taste, and side effects of the preparation (nausea, dizziness, and abdominal cramps). Either of two endoscopists, blinded to the preparation agent used, graded the efficacy of the bowel preparation.

Three patients were excluded from analysis for reasons unrelated to the preparation agents. Bowel preparation was judged by endoscopists to be significantly better in the patients who had taken Fleet® than in those who had taken Picoprep® (P = 0.0014). Further, Fleet® was less likely than Picoprep® to result in residual particulate or solid stool in the colon (P = 0.0035). The incidence of side effects was similar in both groups, although Picoprep® was rated as better tasting.

Although the authors concluded that Fleet® is superior to Picoprep® in bowel preparation, they caution that neither agent is recommended for patients with serious renal or cardiac disorders, or for those taking diuretics. For patients >65 years of age or with such comorbidities, polyethylene-glycol lavage is recommended.