Pilot randomized trial of efficacy and safety of yogic technique versus polyethylene glycol solution for bowel preparation in colonoscopy

Abstract

Background and Aims

The traditional yogic technique of shankha prakshalana (SP) has been known to cleanse the bowel, but its efficacy as a bowel preparation agent in colonoscopy has not been studied widely. We compared the efficacy and safety of SP with split-dose polyethylene glycol (PG) in bowel preparation for colonoscopy.

Methods

Patients undergoing elective colonoscopy were randomized into 2 groups: PG group (n = 47) and SP group (n = 47). Patients in the PG group were given 2 liters of PG 3350 in a split-dose regimen. Patients in the SP group were administered 400 mL of lukewarm saline water followed by a set of 5 asanas (physical exercises) of SP, with each asana performed 8 times under the supervision of a certified yoga trainer (R.M.). This constituted 1 cycle, which was repeated 6 times (total intake of 2400 mL lukewarm saline water). The Boston Bowel Preparation Scale (BBPS) was used to assess the main outcome of the efficacy of bowel preparation.

Results

A total of 94 patients were enrolled, with 47 in each study group. The mean BBPS for the whole colon in the SP group (8.15 ± 1.02) was higher than that in the PG group (7.55 ± 1.08; P = .007). Moreover, the segmental BBPS for the right side of the colon was significantly higher in the SP group (2.64 ± 0.48) than in the PG group (2.36 ± 0.60; P = .010). Adverse effects, such as nausea (31.9% vs 4.3%; P = .001), bloating (27.7% vs none; P < .0001), and disturbed sleep (63.8% vs 12.8%; P < .0001), were significantly more frequent in the PG group than in the SP group.

Conclusions

The traditional yogic technique of shankha prakshalana is an effective method for bowel preparation in colonoscopy, with overall better efficacy and safety, compared with the standard split-dose PG regimen. (Clinical trial registration number: CTRI/2020/07/026899.)