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Bowel Preparation
Aka: Bowel Preparation, Colonoscopy Bowel Preparation, Lower Endoscopy Bowel Preparation
- Indications
- Colonoscopy
- Flexible Sigmoidoscopy
- Protocol: General
- Evening-Morning Protocol
- Split dosing with half of preparation in evening and other half in morning, 4-6 hours before procedure
- Now preferred as Bowel Preparation
- Sedated procedure preparation
- No solids for >6 hours before procedure
- No liquids for >2 hours before procedure
- Bloating or Nausea
- Remain ambulatory as this may reduce symptoms
- Wait longer between doses
- Medications
- Take with sip of water up to 3-4 hours before the procedure
- Stop NSAIDs, iron supplement, fish oil up to 1 week prior to procedure
- Low dose Aspirin can typically be continued (although does increase risk of bleeding from biopsy sites)
- Diabetic medications
- Prep Day (evening prior to procedure)
- Consider decreasing Bolus Insulin (e.g. InsulinLispro) and Sulfonylureas (e.g. Glipizide) to half dose
- Procedure Day
- Consider decreasing basal Insulin dose (e.g. Lantus, Levemir) to half dose
- Protocol: First-Line agents
- Clear Liquid Diet on the evening before procedure
- Do not use any red or purple colored flavorings or liquids
- Protocol 1: PEG Solution such as Golytely (4 Liters)
- May have seawater or sulfur taste
- Consider chilling, drinking with straw and adding citrus flavor crystal light (or lemon juice) for better taste
- Consider sulfate-free PEG (NuLytely, TriLyte) for better taste at reasonable cost ($20)
- Protocol 2: PEG Solution with half the volume (2 Liters)
- Low volume prep: HalfLytely, Moviprep, Plenvu (expensive, $120)
- Administer 2 Liters of the concentrated solution
- Low Volume non-PEG solutions: Suprep, Clenpiq
- Administer 2 Liters of the concentrated solution
- Risk of osmotic Electrolyte shifts and Acute Kidney Injury (esp. if use of NSAIDs, ACE Inhibitors)
- Alternative (low volume at generic cost)
- First: Bisacodyl 10-20 mg orally
- Next (2 hours later): 2 Liters of standard PEG Solution (e.g. Golytely or NuLytely)
- Protocol 3: Tablets with fluid
- Sutab 24 tablets taken with 3 Liters of fluid ($150)
- Osmoprep 32 tablets taken with 2 Liters of fluid ($250)
- Protocol 4: Miralax (better taste)
- First: Bisacodyl 10-20 mg orally
- Next
- Combine Miralax (PEG 3350) and Gatorade (or similar)
- Miralax 238 gram bottle and
- Light colored Gatorade or similar liquid 64 ounces
- Drink 8 ounces of the Miralax-Gatorade every 10 minutes
- Risk of greater Electrolyte losses than with prescription PEG solutions
- Protocol: Prepopik (Stimulant Laxative with Magnesium Citrate)
- Contraindications (use PEG option instead)
- Renal disease with Electrolyte abnormalities
- Congestive Heart Failure
- Advanced age
- Preparation
- Mix one packet with 5 oz water immediately before dose
- Morning procedure
- First
- Take dose 1 on the afternoon of the day before the procedure
- Follow with five 8-ounce glasses of water (40 oz)
- Next
- Take dose 2 at six hours after the first dose
- Follow with three 8-ounce glasses of water (24 oz)
- Afternoon procedure
- First
- Take dose 1 on the evening of the day before the procedure
- Follow with five 8-ounce glasses of water (40 oz)
- Next
- Take dose 2 at five hours before the procedure
- Follow with three 8-ounce glasses of water (24 oz)
- References
- (2012) Presc Lett 19(11):66
- Protocol: Other
- Precautions
- These protocols have fallen into disuse due to concerns about efficacy and safety
- Risk of Hypermagnesemia in elderly
- Protocol 1: Two Laxatives on evening before procedure
- Bisacodyl (Dulcolax) take four 5 mg tablets
- Magnesium Citrate take 290 ml bottle
- Protocol: Older listed for historical reasons (avoid due to nephrotoxicity)
- Protocol 1: Combined Laxative and fleets
- Laxatives on evening before procedure
- Bisacodyl (Dulcolax) take four 5 mg tablets
- Enemas on morning of procedure
- First Fleets Enema 1.5 hours before procedure
- Second Fleets Enema 0.5 hours before procedure
- Third Fleets Enema if second enema fluid not clear
- Protocol 2: Fleet Phospho-Soda
- Fleet Phospho-Soda is one of the most effective and well tolerated preparations
- However, not recommended due to renal Calcium precipitation and Renal Injury risk
- References
- (2014) Presc Lett 21(3)
- (2021) Presc Lett 28(4): 22-3
- Sin Sil Park (2012) Am J Gastroenterol 105: 1319-26 [PubMed]
- Marmo (2010) Gastrointest Endosc 72:313-20 [PubMed]