Bowel Preparation

1. Indications
   1. Colonoscopy
   2. Flexible Sigmoidoscopy
2. Protocol: General
   1. Evening-Morning Protocol
      1. Split dosing with half of preparation in evening and other half in morning
      2. Now preferred as Bowel Preparation
   2. Sedated procedure preparation
      1. No solids for >6 hours before procedure
      2. No liquids for >2 hours before procedure
3. Protocol: First-Line agents
   1. Clear Liquid Diet on the evening before procedure
   2. Protocol 1: PEG Solution (4 Liters)
      1. Consider chilling and adding citrus flavor crystal light for better taste
      2. Consider sulfate-free PEG (NuLytely) for better taste
   3. Protocol 2: PEG with Bisacodyl (HalfLytely)
      1. First: Bisacodyl 10-20 mg orally
      2. Next (2 hours later): 2 Liters of PEG Solution
   4. Protocol 3: Miralax
      1. First: Bisacodyl 10-20 mg orally
      2. Next (2 hours later): 2 Liters of Miralax
      3. Next: Drink Gatorade or other electrolyte drink and additional fluids
4. Protocol: Other
   1. Precautions
      1. These protocols have fallen into disuse due to concerns about safety
   2. Protocol 1: Two Laxatives on evening before procedure
      1. Bisacodyl (Dulcolax) take four 5 mg tablets
      2. Magnesium Citrate take 290 ml bottle
5. Protocol: Older listed for historical reasons (avoid due to nephrotoxicity)
   1. Protocol 1: Combined Laxative and fleets
      1. Laxatives on evening before procedure
         1. Bisacodyl (Dulcolax) take four 5 mg tablets
      2. Enemas on morning of procedure
         1. First Fleets Enema 1.5 hours before procedure
         2. Second Fleets Enema 0.5 hours before procedure
         3. Third Fleets Enema if second enema fluid not clear
   2. Protocol 2: Fleet Phospho-Soda
      1. Fleet Phospho-Soda is one of the most effective and well tolerated preparations
      2. However, not recommended due to renal calcium precipitation and renal injury risk