Bowel preparation for colonoscopy : Efficacy, tolerability and safety

Adequate cleansing of the bowel is important for a reliable and diagnostic colonoscopy. Proper bowel preparation is directly cor- related to the diagnostic performance of colonoscopy, procedure time, cost price and the complication rate. The ideal bowel prepa- ration agent should be efficient, safe and well tolerated by the patient. Numerous agents have become commercially available overtime. Current agents can be classified according to their tonic- ity, as being isotonic or hypertonic. Poly-ethylene glycol based solu- tions balanced with electrolytes are the prototype of isotonic bowel preparations. Poly-ethylene solutions are safe and efficient in cleaning the bowel. Volume related side-effects are common, lead- ing to innovations such as split dosing, and low volume solution combined with another laxative. Sodium phosphate and magne- sium oxide are hypertonic agents. They are efficient and well toler- ated, but safety issues regarding sodium phosphate has hampered its success. Because most physician are likely to prescribe bowel preparation agents for colonoscopy, they should be aware of the range of preparations commercially available and their limitations. This review focuses on the efficacy, tolerability and safety of current available bowel preparation agents. (Acta gastroenterol. belg., 2014, 77, 249-255).