EPD504 - A Prospective Head-to-Head Comparison of Sutab Versus MiraLAX for Bowel Preparation Efficacy and Tolerability in Outpatient Colonoscopy

Purpose/Background: A high quality colonoscopy requires adequate bowel preparation. One of the more recent formulations, Sutab (sodium sulfate, magnesium sulfate, potassium chloride tablets) was developed to improve patient tolerability while maintaining bowel cleansing efficacy. There has yet to be a direct head-to-head comparison between MiraLAX and Sutab bowel preparations. This study aims to directly compare Sutab and MiraLAX with regards to bowel preparation efficacy and patient tolerability.

Methods/Interventions: This was a single center prospective study among 6 colorectal surgeons performing screening, diagnostic, and surveillance colonoscopies at a busy Ambulatory Surgery Center (ASC) between July through October 2025. MiraLAX dosing was 238g of PEG3350 mixed with 64 ounces of Gatorade. Inclusion criteria were adult patients (>18 years) undergoing elective outpatient colonoscopies, split dosing, and those who used either Sutab or MiraLAX. Exclusion criteria were patients with a prior colon resection. The primary outcome was adequate bowel cleansing as measured by the Boston Bowel Preparation Scale (BBPS). Coprimary outcomes include ease of bowel preparation and willingness to repeat the preparation in future colonoscopies. Secondary objectives include adverse events, cecal intubation rate, polyp detection rate, and adenoma detection rate. The use of GLP-1 medications by patients was identified as a potential confounding variable in the study.

Results/Outcomes: A total of 133 colonoscopies (64 MiraLAX, 69 Sutab) were performed and no statistically significant differences were observed between the two groups across any of the measured variables of tolerability or efficacy.
In terms of tolerability, 83% of patients rated MiraLAX as either very easy or easy compared with 70% tolerability in Sutab patients (p = 0.23). Adverse events were similar across both groups including: nausea, vomiting, abdominal pain, and bloating (p = 0.51, p = 0.88, p = 0.80, p = 0.56).
Efficacy, measured by the Boston Bowel Preparation Scale (BBPS), was similar for both regimens. The average BBPS was 7.9 in the MiraLAX group compared to 7.7 in the Sutab group (p = 0.56).
No differences were found in polyp detection (p = 0.99) and subsequently adenoma detection (p = 0.93). The overall adenoma detection rate (ADR) was 30.1%.
The use of GLP-1 receptors did not significantly affect bowel preparation of Sutab and MiraLAX efficacy overall (p = 0.33).

Conclusion/Discussion: In this prospective study, MiraLAX and Sutab demonstrated comparable efficacy for bowel cleansing as measured by the Boston Bowel Preparation Scale, with no statistically significant differences in tolerability or adverse gastrointestinal symptoms. Polyp and adenoma detection rates were similar between groups. Although there was no statistical differences between the groups, this study showed an exceptionally high percentage of patients willing to repeat the same bowel preparation 95.3% (MiraLAX) and 89.9% (Sutab). This compares to historic studies where this ranges between 62-93%. These findings support the use of either MiraLAX or Sutab as effective and well-tolerated options for colonoscopy preparation, consistent with current consensus recommendations. Allowing patients to have an option between pills versus Gatorade-flavored bowel preparation may improve patient satisfaction and is a potential for future research.