Bowel preparation regimen

Recommended Bowel Preparation Regimen (Proposed Surgery Time... 

Enemas commonly are employed either by themselves or as adjuncts to bowel preparation regimens to empty the distal colon or rectum of retained solid material. Bowel distention by any means will produce an evacuation reflex in most people, and almost any form of enema, including normal saline solution, can achieve this. Specialized enemas contain additional substances that either are osmoticaUy active or irritant however, their safety and efficacy have not been studied in a rigorous manner. Repeated enemas with tap water or other hypotonic solutions can cause hyponatremia repeated enemas with sodium phosphate-containing solution can cause hypocalcemia. Phosphate-containing enemas also are known to alter the appearance of rectal mucosa. 

Fluid redistributes between prone and supine imaging (Fig. 14.19). Polyethylene glycol electrolyte solution bowel preparation typically results in more retained colonic fluid, compared to other bowel preparation regimens, but leaves less particulate stool matter in the colon. Fluid can also be seen in 3D endoluminal images (Fig. 14.20). When there is excessive fluid, intravenous contrast can be used to enhance submerged lesions. 

Abbas MI, Nylund CM, Bruch CJ, Nazareno LG, Rogers PL. Prospective evaluation of 1-day polyethylene glycol-3350 bowel preparation regimen in children. J Pediatr Gastroenterol Nutr 2013 56 220-4. 

Bartlett JG, Condon RE, Gorbach SL, Clarke JS, Nichols RL, Ochi S Veterans Administration Cooperative Study on Bowel Preparation for Elective Colorectal Operations Impact of oral antibiotic regimen on colonic flora, wound irrigation cultures and bacteriology of septic complications. Ann Surg 1978,188 249-254. 

Sodium phosphates are considered to be dangerous (1), particularly because of their effects on electrolyte balance. An oral solution of sodium phosphates (dibasic sodium phosphate + monobasic sodium phosphate) is used as a laxative for the relief of occasional constipation and is used as part of a bowel-cleansing regimen in preparing patients for surgery or colonoscopy. 

Despite the large amount of published studies on CTC, there is no consensus about the optimum regimen for bowel preparation. Two commonly used bowel-deansing regimens are polyethylene glycol electrolyte (PEG) lavage solution and saline cathartics such as phospho-soda and magnesium citrate, both of which are available in commercial preparations. Table 17.1 details the most common preparation schemes. 

The recommended treatment regimen for most preparations is twice daily, morning and evening, and after each bowel movement. 

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