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Advances in Bowel Preparations: New Formulation and Clinical Results

Palma, Jack Di MD; Rex, Douglas MD

doi: 10.1097/SGA.0b013e31823080ef
Research Study

Adequate cleansing is essential for a thorough and accurate examination of the bowel during colonoscopy. Suboptimal preparation can lead to missed diagnoses, increased costs, and safety issues. Favorable bowel preparations are efficacious, safe, and cause as little patient discomfort as possible by limiting fluid volume, intolerance, and inconvenience. Split-dose (2-day) regimens address these concerns and are associated with better cleansing and higher patient satisfaction than with single-dose regimens. Nurses can play a key role in communicating the benefits of various bowel preparation options, including split dosing, to patients.

A low-volume oral sulfate solution given as a split-dose regimen has been tested in randomized clinical trials and found to provide similar bowel cleaning to split-dose polyethylene glycol with electrolytes and ascorbic acid (PEG-EA). Superior cleaning was found when compared with single-dose polyethylene glycol with electrolytes (PEG-ELS), particularly in the cecum and ascending colon. With the exception of clinically insignificant changes in electrolytes, tolerability and safety were similar between patients taking oral sulfate solution and patients taking PEG-EA or PEG-ELS. Oral sulfate solution is a safe and effective low-volume bowel preparation for colonoscopy.

Jack Di Palma, MD, is Professor of Medicine, Director of Division of Gastroenterology, University of South Alabama College of Medicine, Mobile, Alabama.

Douglas Rex, MD, is Professor of Medicine, Director of Endoscopy, Division of Gastroenterology and Hepatology, Indiana University Hospital, Indianapolis, Indiana.

Correspondence to: Jack Di Palma, MD, Division of Gastroenterology, University of South Alabama College of Medicine, 5600 Girby Road, Mobile, AL 36693 (e-mail:

Disclaimer: This article is designed solely to provide the healthcare professional with information to assist in his or her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional and, therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. Advanced Medical Resources LLC, the authors, the coordinators, the reviewers, and the publisher specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through the reader's misunderstanding of the content.

Received July 01, 2011

Accepted July 31, 2011

© The Society of Gastroenterology Nurses & Associates 2011. All Rights Reserved.