Finding the Best Prep for Your Colonoscopy

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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The main complaint concerning colonoscopy is not the procedure itself but rather the preparation necessary for proper colon cleansing. Patients are placed on a clear liquid diet the day before a colonoscopy, and will be asked to take a solution to clean the colon out. The common complaints from people who endure the prep the day before their colonoscopy include nausea, bloating and vomiting.

It’s important to finish the prep because if you don’t do it well, the procedure is useless as they won’t be able to visualize anything . . . then you have to do it all over again. Scared? You don’t have to be.

The standard used to be that you would drink four liters of polyethylene glycol (PEG). Many folks couldn’t tolerate drinking it leading to vomiting, nausea and incomplete preparation before your colonoscopy.

Several players have come on board to ease the awful prep. So what is the best colonoscopy prep?

1. A 4 Liter solution of polyethylene glycol (PEG) is known as GoLYTELY and was the old standard but now comes in a more condensed version.

2. A reduced volume version of GoLYTELY has become available in a 2 Liter solution (Moviprep or Half-Lytely). This is good because it’s only 2 Liters. Moviprep is commonly used now as the first choice.

3. Fleet Phospho-soda had a promising beginning because it is diluted in several glasses of water or ginger ale and is much less volume to drink. The problem, which is why it’s not often used, is that it is known to be associated with kidney injury.

4. OsmoPrep is a tablet option! But wait – these are sodium phosphate tablets that have also been associated with kidney problems (acute phosphate toxicity) so they carry a black box warning.

5. The new prep being studied is Miralax (polyethylene glycol powder) mixed with 64 ounces of Gatorade. While not FDA approved for this indication, it has been widely used and is an accepted alternative to GoLYTELY in numerous endoscopy centers across the country. Stay tuned on this.

Dr O.

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