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Although low-volume, nonpolyethylene glycol (PEG) regimens are widely used in clinical practice, real-world comparative data between stimulant-based preparations and sodium picosulfate-based combinations remain limited. This study aimed to compare the effectiveness and tolerability of sennoside A\u2009+\u2009B versus sodium picosulfate\/magnesium oxide\/citric acid (PM\/Ca) using the Boston Bowel Preparation Scale (BBPS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective, randomized, observer-blinded trial included adults aged 18\u201380\u00a0years undergoing elective outpatient colonoscopy. Participants were randomized 1:1 to receive either sennoside A\u2009+\u2009B oral solution (split-dose: 250\u00a0mL at 21:00 and 250\u00a0mL at 23:00) or PM\/Ca (two sachets at 19:00 and 21:00), both administered with a low-residue diet and written instructions; rectal enemas were applied as part of the institutional protocol. Bowel cleanliness was assessed using BBPS. Adequate preparation was defined as BBPS\u2009&gt;\u20096. Multivariable logistic regression was performed to identify independent predictors of adequate preparation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 705 patients were included in the primary analysis cohort (341 sennoside A\u2009+\u2009B; 364 PM\/Ca). Adequate bowel preparation (BBPS\u2009&gt;\u20096) was achieved more frequently in the sennoside A\u2009+\u2009B group than in the PM\/Ca group (70.1% versus 56.3;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and the mean BBPS score was higher (6.64\u2009\u00b1\u20091.78 versus 5.93\u2009\u00b1\u20091.92;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Polyp detection rates were similar between groups (21.4% versus 26.6;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.138). In multivariable analysis, higher education (OR 1.38; 95% CI 1.06\u20131.81;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016) and sennoside A\u2009+\u2009B (OR 1.77; 95% CI 1.29\u20132.43;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) were independent predictors of adequate preparation, whereas age, BMI, sex, diabetes mellitus, and constipation were not. Preparation intolerance was more frequent in the sennoside A\u2009+\u2009B group (7.0% versus 0.7%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; tolerance analysis\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009824). Failure to reach the cecum did not differ significantly between regimens (9.3% versus 12.3%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.216; analyzed in the entire study population\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009791).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In routine clinical practice, sennoside A\u2009+\u2009B provided higher cleansing efficacy than PM\/Ca as reflected by higher BBPS scores and a greater probability of achieving adequate bowel preparation. However, PM\/Ca demonstrated a more favorable tolerability profile. Bowel preparation selection should balance efficacy and tolerability while considering patient-related factors such as educational level.<\/jats:p>\n                    <jats:p>\n                      <jats:italic>Trial registration:<\/jats:italic>\n                      ClinicalTrials.gov, NCT06580366.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10151-026-03336-2","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T16:26:06Z","timestamp":1778775966000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of sennoside A\u2009+\u2009B and sodium picosulfate-based regimens for bowel preparation: a prospective randomized trial"],"prefix":"10.1007","volume":"30","clinical-trial-number":[{"clinical-trial-number":"nct06580366","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9032-0977","authenticated-orcid":false,"given":"\u0130.","family":"Durak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9846-1021","authenticated-orcid":false,"given":"M.","family":"\u00d6zden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6279-1018","authenticated-orcid":false,"given":"T.","family":"D\u00fczenli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3443-1987","authenticated-orcid":false,"given":"M.","family":"Sade\u00e7olak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7514-1962","authenticated-orcid":false,"given":"M.","family":"Kaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2197-7473","authenticated-orcid":false,"given":"H.","family":"K\u00f6seo\u011flu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"3336_CR1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-154-1-201101040-00004","volume":"343","author":"H Brenner","year":"2011","unstructured":"Brenner H, Chang-Claude J, Seiler CM, Rickert A, Hoffmeister M (2011) Protection from colorectal cancer after colonoscopy: a population-based, case-control study. 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