A review of current issues underlying colon cleansing before colonoscopy

Area of Science:

• Gastroenterology
• Clinical Pharmacy

Background:

• Colon cleansing is crucial for colonoscopy efficacy.
• Several agents exist, including oral sodium phosphate (NaP), polyethylene glycol (PEG), and magnesium citrate (Pico-Salax).
• Patient tolerance, safety, and efficacy vary among these agents.

Purpose of the Study:

• To review current issues concerning the efficacy, patient tolerance, and safety of NaP, PEG, and Pico-Salax.
• To examine the role of diet in bowel preparation.
• To identify areas for further research in colon cleansing.

Main Methods:

• Systematic literature search of MedLine and PubMed databases.
• Focused on altered PEG solutions with adjuncts, Pico-Salax efficacy/safety, NaP-associated nephrocalcinosis/renal failure, and diet's role.
• Review of existing studies and case reports.

Main Results:

• Lower-volume PEG solutions with adjuncts may improve tolerance but have varied efficacy.
• Limited data exists for Pico-Salax, but it may be better tolerated than NaP and PEG.
• Potential association between NaP and nephrocalcinosis requires further investigation.
• Liberalized diets may enhance tolerability without compromising efficacy for some regimens.

Conclusions:

• Further research is needed to establish definitive conclusions on Pico-Salax efficacy and safety.
• The association between NaP and nephrocalcinosis needs more extensive study.
• Optimizing bowel preparation regimens through diet and agent selection can improve patient experience and colonoscopy outcomes.