Most of the time, the GI fellow will lay out a step-by-step recipe to the perfect bowel prep. But, you may wonder, what is the secret to that special combinations that turns your patients’ guts quivering and clear-running?
There are several types of agents that can be used in a bowel prep:
- Polyethylene glycol (PEG) formulations: the most benign but does require pt to drink at least 4 L fluid
- Sodium phosphate: much smaller amount (500 mL) and powerful but not for renal patients, IBD pts, or those you’d be concerned about hypokalemia in
- Magnesium citrate: effective, but not for use in renal patients, can be bought over-the-counter
- Bisacodyl may improve low-volume PEG preps, but is a weak adjunct
- Enemas may be used as an adjunct
Studies have shown that a “split” approach–taking some of the prep the day before and some of the prep the day of–is much more effective than just one day, although some countries, like Japan, get by just fine with one day.
Patient is a tough prep? Some advocate a “tough” approach to difficult-to-clean-out patients: one study gave an “intensive” bowel preparation schedule (low fiber diet for 3 d, liquid diet the day before, 10 mg bisacodyl, 3 L of split PEG) to patients with poor cleansing previously (most of the cases with preparation given the day before). The only dietary modification found to help patients prep is a clear liquids diet. Telling patients to eat low-fiber diets for the preceding week may be helpful.