Background
Inadequate bowel, constipation
An adequate bowel preparation for colonoscopy is necessary to visualize the mucosa and safely reach the cecum. Inadequate bowel cleansing remains an issue for up to 20% of those undergoing a colonoscopy [A high percentage of those who had a previous inadequate preparation for colonoscopy have a subsequent inadequate preparation. A retrospective study [Two studies [In the United States, pure PEG-3350 powder is sold over-the-counter by the gram in sachets (packages) of 17 g or bottles ranging in size from 119 to 765 g for use as a laxative with a recommended dose of 17 g. PEG-3350 with electrolytes is sold by prescription for cleansing the colon for colonoscopy and is rarely used for constipation. In other parts of the world, PEG-4000 is sold as a laxative but there has never been a comparison of the osmotic effect of PEG-3350 vs. PEG-4000 when used a laxative in humans [A number of studies [Since 2008, our clinic almost exclusively used moderate (306 g to 357 g) doses of PEG in 1.9 l (64 oz) of Gatorade as our standard colonoscopy preparations. For those whose previous preparations were almost adequate, we use 374 g of PEG and Gatorade given as a split-dose. For those whose previous preparations were fair or poor, we use high doses (459 g to 612 g) of PEG and Gatorade with a dose chosen that was higher than the previous failed dose and given as a split dose over an extended period of time. This extended high-dose cleansing protocol seemed to have a high efficacy and be well tolerated.This prospective study reports the efficacy of a multi-step escalating high-dose extended cleansing protocol for those whose previous colon preparations were inadequate. The primary objectives of this study were to examine the efficacy and safety of high-dose PEG and Gatorade preparations for a morning colonoscopy. Secondary objectives of this study were to examine tolerability and patient acceptance of high-dose bowel preparations.