We are using the 4 liters of PEG solution as a standard for the colonoscopy preparation in our ward. Some new data regarding the split dose prep has been newly published. I have also seen a manuscript, in which a capsule of Colpermin improved the colonoscopy procedure. Has anyone any experience with these kinds of prep? Do you recommend them? Is there any other addition to the standard colon prep regimen that can help in terms of better colon prep, faster procedure time and also patient's satisfaction?
We are using a combination of peg and senna(senagraph syrup) 1 lit of peg + one buttle of senagraph the day before and the same on the morning of exam.
This is bowel preparation for Colonoscopy Examination in Dr. Sardjito Hospital ,Yogyakarta,Indonesia:
1.A day before colonoscopy , the patient only take pourridge diet all day ( we usually add soybean ketchup). Patient may drink water or other beverages except that make residue in the guts.
2.In the evening, 08.00 PM , patient drink one bottle of sodium phosphosoda that has been diluted in a half glass of water. Patient drink one-third of a glass at a time with 5 minutes interval (because patient may suffer from nausea or vomitus when drink it at once). Then the patient take another a glass of water . After that the patient take meal fasting but allow to drink water as long as the patient want to, until the colonoscopy procedure is performed in the morning (07.00-09.00 AM)
This bowel prep useful also for water method colonoscopy and give excellence view in most of our patients.
Dear Dr Taghavi
I would like to thank you for your answer and collaboration. I would like to know if this regimens, namely the combination of PEG and senna is evidence based or is it your own experience? Have you ever compared it with the usual 4 liters of PEG alone?
Dear Putut
Thanks for the reply. The use of a pourridge diet was interesting for me with soybean ketchup! Is it something made with milk and additives? Don't you have any residue after that. have you ever used PEG instead of sodium phosphosoda? Any electrolyte problem in your patients?
It is not made with milk, additives is depend on the patients. Residue was still found in some cases but did not disturb cecal intubation. Ambulatory patients have better bowel prep in many cases. I do not use PEG because this agent was just available since 6 months ago in our country. Sodium Phosphosoda has been available since 5 years ago.
We use Sodium picosulfate powder (2x150 ml) in split dose for preparation. Patients have to drink 4 l uf pure water afterwards. the results are excellent and comparable with peg, but patients do not complain about bad taste.
Dear Andreas
What about the price? Which prep is cheaper? Have youhad any complication seen with picosulphate powder?
The price for 2 bags of sodium picosulfate in Germany is 22€. I did not see severe compications, only vomiting in some patients.
As a rule, we use macrogol (Endofalk or Fortrans), but often we get a lot of dirty water in the intestinal lumen.
I think, the best is castor oil & several good cleansing enemas with hypertonic solution performed by experienced personnel :))) The result is a clean mirror... (is a joke, but partly...)
Phosphosoda now a days is NOT recommended for bowel preparation, because of the risk of acute Kidney injury that often is reversible but in some may lead to chronic kidney disease. In fact 2-3 years ago, FDA had a Black-box Warning.
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