Cleaning for Colonoscopy

GoLytely better prepares the colon for screening colonoscopy than MiraLAX, report Michael Hjelkrem et al. in the April issue of Clinical Gastroenterology and Hepatology.

Efficient cleansing of the colon is one of the most important factors for successful colonscopy examination, but also a major reason that patients avoid screening—because of unpleasant taste and side effects. Nonetheless, the degree of colon cleanliness correlates with the number of polyps detected.

Hjelkrem et al. compared the efficacy and tolerability of 2 commonly used methods for colon cleansing—MiraLAX (PEG 3350 without electrolytes) and GoLytely (PEG 3350 with electrolytes)—in screening colonoscopies of 403 patients. Groups were given 4 liters of MiraLAX, with or without bisacodyl or lubiprostone, or 2 liters of GoLytely.

They found that GoLytely cleaned the entire colon significantly better than MiraLAX, alone or in combination with the cleansing agents lubiprostone or bisacodyl. MiraLAX was also associated longer procedure times.

Comparison of Bowel Preparations

However, patients liked the MiraLAX more, probably because it tasted better, and there was a  smaller volume to drink. Nonetheless, there were no significant differences among the bowel cleansing regimens in adverse events or symptoms of nausea, abdominal cramping, or bloating.

Hjelkrem et al. raised concern that the absence of electrolytes from the MiraLAX formulation studied increases the risk for electrolyte imbalance—specifically hyponatremia. Although the authors did not check serum samples for signs of these complications, there were no deaths or side effects that led to hospitalization. If hyponatremia did occur, they say it was not clinically insignificant.

The authors propose that optimizing the use of cleansing regiments will reduce screening costs and thereby increase the number of patients examined for colon cancer. They state that MiraLAX should not be used if efficacy is the most important factor in bowel preparation, but could be considered for its palatability factors.

In an accompanying editorial, Frederick Weber adds that colonic preparation regimens must be customized for difficult-to-cleanse patients such as the elderly, obese and chronically constipated, and for patients who take narcotics or tricyclic antidepressants.

Weber says that colonoscopists and their patients should be pleased with recent advances in the efficacy and tolerability of colon preparation process, which have resulted in less-restrictive diets, a single-day process and less intrusion in patient’s lives. These advances will increase the number of patients that receive CRC screening and reduce mortality.

More Information on Colonoscopy:

Read the article online.
Hjelkrem M, Stengel J, Liu M, et al. MiraLAX is not as effective as GoLytely in bowel cleansing before screening colonoscopies. Clin Gastroenterol and Hepatol 2011;9:326–332.e1.

Read the accompanying editorial.
Weber FH. Optimizing colonic preparation: the solution is becoming clearer and clearer. Clin Gastroenterol and Hepatol 2011;9:286–289.

About Kristine Novak, PhD, Science Editor

Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology, both published by the American Gastroenterological Association. She has worked as an editor at biomedical research journals and as a science writer for more than 12 years, covering advances in gastroenterology, hepatology, cancer, immunology, biotechnology, molecular genetics, and clinical trials. She has a PhD in cell biology and an interest in all areas of medical research.
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