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bowel preparation (whole bowel irrigation, bowel evacuation)

Indications: 1) prepare the bowel for endoscopy or surgery 2) ingestion of poison, drug overdose (use Polyethylene glycol) a) ingestion of massive amounts of a toxic substance b) ingestion of metals (iron, Li+) that do nod adsorb to activated charcoal c) ingestion of sustained-release pharmaceuticals d) body packers (wrapped packages of cocaine, heroin) e) ingestion of large pills or foreign bodies f) concretions Procedure: A clear liquid diet for 24-48 hours prior to the procedure can improve the quality of bowel preparation [7] Patients should reduce fiber intake or supplementation 1 week before the procedure [7] Magnesium citrate: 1) alone or in combination with other laxatives 2) liquid diet necessary for 24-48 hours 3) drink plenty of fluids to prevent dehydration Polyethylene glycol (PEG) solutions 1) Go-Lytely, CoLyte 2) works well without causing electrolyte imbalances 3) tastes bad 4) 4 liters of fluid 5) a split preparation, 2 liters given the night before & 2 liters given the morning of the procedure is the most effective approach to improving the quality of a bowel preparation [7] Use polyethylene glycol (PEG) solutions in high-risk patients Older patients with renal insufficiency [10] Generally safe for all patients [10] Sodium phosphate solution (Fleet Phospho-soda) 1) often better tolerated because patients drink a smaller amount 2) may combine with bisocodyl 20 mg (4 x 5 mg tabs) [2] 3) may cause water & electrolyte disturbances - dehydration, hyperphosphatemia, hypokalemia, hypocalcemia 4) may cause acute renal failure [5] Sodium phosphate tablets (Visicol) 1) better tolerated than most preps 2) 40 tablets total; 20 in PM, 20 in AM of procedure 3) take 3 tablets at a time with 8 oz of water every 15 min Suprep & Sutab [8] AVOID sodium phosphate in patients with: 1) congestive heart failure 2) unstable angina 3) impaired renal function 4) liver disease Avoid iron within one week of procedure. - iron interferes with visualizing the colon Avoid NSAIDs within one week of procedure. - NSAIDs increase the risk of bleeding if polyps are removed. patients takinng GLP-1 agonists (glutides) have lower quality of bowel preparations & are more like likely to be called back for repeat [11] Walking aids bowel preparation [3]

General

clinical procedure

References

  1. Prescriber's Letter 8(1):2 2001
  2. Journal Watch 24(24):187, 2004 Hookey LC, Depew WT, Vanner SJ. A prospective randomized trial comparing low-dose oral sodium phosphate plus stimulant laxatives with large volume polyethylene glycol solution for colon cleansing. Am J Gastroenterol. 2004 Nov;99(11):2217-22. PMID: 15555005
  3. Kim HS, Park DH, Kim JW, Jee MG, Baik SK, Kwon SO, Lee DK. Effectiveness of walking exercise as a bowel preparation for colonoscopy: a randomized controlled trial. Am J Gastroenterol. 2005 Sep;100(9):1964-9. PMID: 16128940
  4. Prescriber's Letter 16(2): 2009 CHART: Comparison of Bowel Prep Agents GUIDELINES: Consensus Document on Bowel Preparation Before Colonoscopy GUIDELINES: Canadian Association of Gastroenterology Position Paper on Commonly Used Preparations for Colonoscopy: Efficacy, Tolerability and Safety Detail-Document#: 250205 (subscription needed) http://www.prescribersletter.com
  5. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
  6. Prescriber's Letter 19(6): 2012 Comparison of Bowel Preps Detail-Document#: 280602 Detail-Document#: 281111 (subscription needed) http://www.prescribersletter.com
  7. Kilgore TW et al. Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials. Gastrointest Endosc 2011 Jun 2; 73:1240. PMID: 21628016 - Wexner SD et al. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Gastrointest Endosc 2006 May 31; 63:894. PMID: 16733101 (corresponding NGC guideline withdrawn Nov 2016)
  8. From: The Medical Letter on Drugs and Therapeutics. March 8, 2021;63(1619):33-36 Sodium Sulfate-Based Tablets (Sutab) for Colonoscopy Preparation. JAMA. September 24, 2021 https://jamanetwork.com/journals/jama/fullarticle/2784620
  9. ASGE Standards of Practice Committee. Bowel preparation before colonoscopy. Gastrointest Endosc 2015 Apr; 81:781-94. PMID: 25595062 https://www.giejournal.org/article/S0016-5107(14)02268-8/fulltext
  10. NEJM Knowledge+ Complex Medical Care
  11. Yao R, Gala KS, Ghusn W et al EFFECT OF GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS ON BOWEL PREPARATION FOR COLONOSCOPY. Am J Gastroenterol. 2023 Oct 19. PMID: 37856247 https://journals.lww.com/ajg/abstract/9900/effect_of_glucagon_like_peptide_1_receptor.921.aspx