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Saturday, January 26, 2013

Colonoscopy Prep Made Easy: A New Cleanser

Many people who have gone through a colonoscopy to screen for colon cancer will tell you that the worst part is not the procedure itself (since you are asleep during it) but the preparation. The colon is the major part of the large intestine. In a colonoscopy, a flexible viewing scope is placed inside of the colon to examine for abnormalities, some of which can be removed with other devices during the procedure.

For colonoscopy to be effective, the colon must be properly cleansed of feces. The standard way that this is done is by not eating the day before, consuming clear liquids, and drinking a large amount (2 to 4 liters) of an intestinal cleanser which causes diarrhea throughout the day. The worst part of the cleanser is often described as the consistency and the taste because it is quite salty and somewhat thick. These cleansers typically contain a chemical substance known as polyethylene glycol (PEG) that forms the basis of a laxative.

Many people simply cannot stomach these cleansers, vomit or gag while drinking it, and thus do not comply with its use. This can result in the procedure being cancelled or a less thorough exam. Worst of all, hearing stories about this can result in people deciding not to go for a colonoscopy at all (or not to return for one in the future) and thus not detecting and removing pre-cancerous masses. This is a problem, considering that 50,000 people died from colorectal cancer in the U.S. in 2011. Thus, a better option for intestinal cleansing is needed.

In a recent development, the U.S. Food & Drug Administration approved a newer and alternative intestinal cleaning solution for colonoscopy preparation known as Prepopik. In scientific literature, it is sometimes referred to as P/MC because it contains sodium picosulfate and magnesium citrate, both of which work as laxatives, the former by stimulating intestine movement (peristalsis) and the latter by causing water absorption. This is why P/MC is referred to as a dual action cleanser. It is fascinating that it took so long for this to be approved in the U.S. since similar cleansers have been used for about 40 years throughout the world with established safety, effectiveness, and tolerability.

In an upcoming article in the American Journal of Gastroenterology, researchers summarized the results of a head to head comparison between the new intestinal cleanser (P/MC) and the standard cleanser (2 liters of PEG-3350, natural orange flavor) combined with two 5 milligram bisacodyl tablets (another type of laxative). The study involved randomly assigning 603 adults (ages 18 to 80) to one type of intestinal cleanser or the other. The results of the study showed that the new cleaner (P/MC) was just as effective as a cleanser and that patients rated it as significantly more tolerable and acceptable.

These results are great news because no longer will people need to drink 2 liters (67 ounces) of PEG-based cleansers. With Prepopik, you consume only 10 ounces of prep followed by 64 ounces of an approved clear liquid on a more flexible timing schedule. If you are going for a colonoscopy in the future, you can ask your doctor about Prepopik.

Suggested reading:  American Cancer Society's Complete Guide to Colorectal Cancer

Related blog entry: Liver Transplants Increase Survival Rate for Non-Resectable Colorectal Metastases

Reference: Katz PO, Rex DK, Epstein M, Grandhi NK, Vanner S, Hookey LC, Alderfer V, Joseph RE. (2013, in press). Am J Gastroenterol. A Dual-Action, Low-Volume Bowel Cleanser Administered the Day Before Colonoscopy: Results From the SEE CLEAR II Study.

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