Miralax (PEG 3350) vs. Golytely as Bowel Preparation for Screening Colonoscopy
A major limitation to the widespread acceptance of colonoscopy as a procedure to screen for
colorectal cancer is the laxative preparation. Phosphate-based preps (e.g. Fleets
Phosphosoda) are now used on a limited basis because of their known association with renal
injury. Polyethylene glycol (PEG) mixed with a balanced electrolyte solution (e.g. Golytely)
has been used for over two decades for colon cleansing. The mixture is not very palatable
due to the electrolyte additives which include sodium sulfate.
To overcome the limitation of existing preps, gastroenterologists and colorectal surgeons
worldwide have been using PEG powder alone (same quantity as found in Golytely prep) not
mixed with electrolytes (Glycolax or Miralax) and dissolving this into 64 ounces of
Gatorade. Conservatively, we estimate that 25% of colonoscopies in the US are being done
with this prep. Anecdotally there have been reports (case series) that it is far more
palatable and the prep is equally efficacious. The active ingredient, PEG, is not changed
and therefore this is not surprising. The issue at present is that there has never been a
blinded study to confirm these claims.
This study will compare the efficacy of the two preps. There is no funding. The
investigators will charge insurance companies for the prep - this is our current practice.
The procedures will be done on healthy individuals referred for colon cancer screening and
the exam will be billed to their insurance. There will be no patient honorarium. The
investigators will check electrolytes to be sure patients do not develop hypokalemia with
the Gatorade prep.
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