What are the colonoscopy preparation options for a patient with a sensitive stomach?

From the Guidelines

For a patient with a sensitive stomach, a low-volume split-dose preparation is recommended for colonoscopy preparation, as it improves tolerability and cleansing effectiveness. When considering the options, it's essential to take into account the patient's medical history, medications, and prior colonoscopy experiences, as suggested by the US Multi-Society Task Force on Colorectal Cancer 1. The task force strongly recommends using a split-dose bowel cleansing regimen for elective colonoscopy, with the second dose ideally starting 4–6 hours before the procedure time 1.

Some key points to consider for patients with sensitive stomachs include:

• Using low-volume preparations such as SUPREP, PLENVU, or SUTAB tablets instead of large-volume preparations like GoLYTELY
• Implementing the split-dose method, where half the preparation is taken the evening before and the other half about 4-6 hours before the appointment
• Minimizing nausea with prescribed anti-nausea medication like ondansetron (Zofran) 30 minutes before starting the prep solution
• Drinking the solution chilled and using a straw to bypass taste buds
• Taking slow sips with breaks in between and sucking on lemon slices or hard candies to manage the taste
• Staying well-hydrated with clear liquids throughout the prep process, while avoiding red, purple, or blue liquids

By following these guidelines and using a low-volume split-dose preparation, patients with sensitive stomachs can undergo colonoscopy preparation with improved tolerability and effective colon cleansing, as supported by high-quality evidence from the US Multi-Society Task Force on Colorectal Cancer 1.

From the Research

Colonoscopy Preparation Options for Sensitive Stomachs

• For patients with sensitive stomachs, several colonoscopy preparation options are available, including:
  • Low-volume split-dose polyethylene glycol (PEG) regimen 2
  • Same-day morning PEG regimen 2
  • 2-Litre polyethylene glycol-citrate-simethicone plus bisacodyl 3
  • Magnesium citrate capsules and bisacodyl (MCCB) 4
  • Low-volume bowel preparation with PEG-based formulations, such as PEG-Citrate-Simethicone (PEG-CS) with bisacodyl or PEG-Ascorbate (PEG-ASC) 5

Characteristics of Each Option

• Low-volume split-dose PEG regimen:
  • Involves taking 1 L of PEG between 6:00 PM and 7:00 PM on the preceding day and another liter between 6:00 AM and 7:00 AM on the day of colonoscopy 2
  • May be less effective than same-day morning PEG regimen in terms of bowel preparation quality 2
• Same-day morning PEG regimen:
  • Involves taking 2 L of PEG between 5:00 AM and 7:00 AM on the day of colonoscopy 2
  • May be more effective than low-volume split-dose PEG regimen in terms of bowel preparation quality 2
• 2-Litre polyethylene glycol-citrate-simethicone plus bisacodyl:
  • May be more acceptable for patients in terms of ease of administration, willingness to repeat, and compliance 3
  • May perform better than standard 4-L PEG regimen in terms of colonic mucosa visualization 3
• Magnesium citrate capsules and bisacodyl (MCCB):
  • May be a low-cost option for patients reluctant to consume a liquid preparation 4
  • May have superior patient satisfaction compared to traditional liquid preparations 4
• Low-volume bowel preparation with PEG-based formulations:
  • May provide equivalent cleansing with improved tolerability compared to standard PEG bowel preparation 5
  • May have similar tolerability, safety, acceptability, and compliance compared to other low-volume bowel preparations 5

Recommendations

• The European Society of Gastrointestinal Endoscopy (ESGE) recommends a split regimen of 4 L of polyethylene glycol (PEG) solution or a same-day regimen in the case of afternoon colonoscopy for routine bowel preparation 6
• The ESGE also recommends against the routine use of sodium phosphate for bowel preparation due to safety concerns 6