Procedure
Bowel Preparation
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Bowel Preparation
, Colonoscopy Bowel Preparation, Lower Endoscopy Bowel Preparation
Indications
Colonoscopy
Flexible Sigmoidoscopy
Protocol
Gene
ral
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
NSAID
s, 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.
Insulin
Lispro
) and
Sulfonylurea
s (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
NSAID
s,
ACE Inhibitor
s)
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
Laxative
s 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
Laxative
s 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]
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