Comparing the efficacy of mannitol and polyethylene glycol in treating patients with poor bowel preparation - a randomized controlled clinical study

Sep 30, 2026

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Colorectal cancer remains a global health concern, making effective bowel preparation essential for diagnostic colonoscopy. This prospective randomized controlled trial evaluated whether oral mannitol and oral polyethylene glycol (PEG) solutions provide comparable efficacy and tolerability for repeat colonoscopy inpatients with inadequate bowel preparation. Eligible participants were adults aged 18–75 with low Boston Bowel Preparation Scale scores (≤1) in any colon segment. Primary outcomes used BBPS scores, with adverse events, taste preference, and satisfaction assessed as secondary endpoints.

LanguageEnglish

CategoryHealthcare

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Pages8

Reading Time20 min

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Abstract

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Study design and population

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Techniques in Coloproctology (2026) 30:15 [https://doi.org/10.1007/s10151-025-03243-y](https://doi.org/10.1007/s10151-025-03243-y) Comparing the efficacy of mannitol and polyethylene glycol in treating patients with poor bowel preparation: a randomized controlled clinical study S. Zheng1,2 · Z. Xu3 · F. Deng1 · S. Wang1,2 · T. Qian1,2 · P. Lin1,2 · C. Wang1 · W. Wang1 · Y. Xia3 · L. Xu1,2 · Z. Zhang1 Received: 10 December 2024 / Accepted: 16 October 2025 © The Author(s) 2025 Abstract Background Colorectal cancer (CRC) remains a global health concern, underscoring the importance of effective bowel preparation for diagnostic procedures such as colonoscopy. This randomized controlled trial was designed to compare the efficacy and tolerability of orally administered mannitol and polyethylene glycol (PEG) solutions for repeat colonoscopy inpatients with inadequate bowel preparation. Methods This prospective, open-label, noninferiority, blinded end point, randomized controlled clinical trial enrolled patients from two centers. Participants aged 18–75 years with Boston Bowel Preparation Scale (BBPS) scores ≤ 1 in any colon segment were included. The study employed a 1-L mannitol or PEG solution, with primary outcomes assessed using BBPS scores. The secondary outcomes included adverse events, taste preferences, and patient satisfaction. A simple randomization strategy was employed, and both intention-to-treat (ITT) and per-protocol (PP) analyses were conducted. Results A total of 134 patients were included in the study, and the trial demonstrated the noninferiority of mannitol compared to PEG in achieving adequate bowel preparation (difference 3.0%, 95% confidence interval − 5.0 to 11.0%) . Mannitol exhibited favorable trends in BBPS scores, highlighting its effectiveness. The safety profiles of the two solutions were comparable, with a low incidence of adverse events (17.9% vs. 19.4%, P = 0.825) . Notably, mannitol outperformed PEG in terms of patient satisfaction and a greater inclination for reuse. Conclusion The findings suggest that orally administered mannitol is not inferior to orally administered PEG in patients with inadequate bowel preparation. Registration number [ClinicalTrials.gov, NCT05912114. Registered on 12/6/2023.](ClinicalTrials.gov, NCT05912114. Registered on 12/6/2023.) Keywords Colorectal cancer · Colonoscopy · Bowel preparation · Mannitol · Polyethylene glycol Introduction Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. According to 2020 global cancer statistics, colorectal cancer has an incidence rate of 10% and a mortality rate of 9.4%[1] . The majority of colorectal * Z. Zhang [fyyzhangzhixin@nbu.edu.cn](fyyzhangzhixin@nbu.edu.cn) 1 Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China 2 College of Medicine, Ningbo University, Ningbo 315211, China 3 Department of Gastroenterology, Ninghai Second Hospital, Ningbo 315600, China cancers arise from the transformation of benign lesions, notably colorectal polyps [2]. Colonoscopy and endoscopiccolonic polypectomy are recognized as pivotal factors in reducing both the morbidity and mortality associated with CRC [3]. These procedures are now endorsed by numerous national guidelines [4] . However, the effectiveness of colonoscopy is contingent upon the quality of bowel preparation, with up to one-quarter of patients experiencing inadequate bowel preparation [5] . Despite ongoing research into bowel cleansing protocols, such as dietary modifications, laxative agents, and cleansing regimens [6 , 7], instances of insufficient bowel preparation persist during colonoscopies [6, 8, 9] . Current guidelines recommend implementing repeat measures in cases of inadequate bowel preparation or rescheduling the endoscopy [10] . However, approximately 30% of patients do not adhere to physicians’ instructions for rescheduling tests effectively [11] . Same-day remedies

FAQs

What was the main aim of comparing mannitol and PEG in this trial?

The trial aimed to compare the efficacy and tolerability of oral mannitol versus oral polyethylene glycol for repeat colonoscopy patients with inadequate bowel preparation.

Who were the participants and how were they selected?

Adults aged 18–75 years were enrolled from two centers, with Boston Bowel Preparation Scale (BBPS) scores ≤1 in any colon segment.

What outcomes were used to evaluate effectiveness and tolerability?

Effectiveness was assessed using BBPS scores, while secondary outcomes included adverse events, taste preferences, and patient satisfaction.

Sep 30, 2026

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