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Can nutritional supplements and rectal enema be used as bowel cleansing for colonoscopy?

The most recent issue of the Scandanavian Journal of Gastroenterology tested the preparation of the gut using oral nutritional supplements and rectal enema as an alternative method of bowel cleansing.

News image

Currently available preparations for colonoscopy have low tolerability and may cause fluid and electrolyte shifts.

An alternative method of bowel cleansing is required.  

Dr Ulf Gustafsson and colleagues from Sweden tested the preparation of the gut using oral nutritional supplements and rectal enema as an alternative method of bowel cleansing.

During 2008–2012, patients were randomized to oral nutritional supplements for 5 days and rectal enema or polyethylene glycol (PEG) prior to colonoscopy.

Blinded endoscopists rated the degree of bowel cleansing according to the Ottawa bowel preparation scale (OBS) (primary outcome).

Tolerability of either preparation was also assessed.

35% of patients receiving PEG had an Ottawa bowel preparation scale score ≤4
Scandanavian Journal of Gastroenterology

Due to a high rate of bowel cleansing failure among patients receiving oral nutritional supplements, the study was interrupted prematurely.

The team observed that colonoscopies were incomplete due to stools in 6 of 27 patients in the oral nutritional supplements group compared to 1 of 23 in the PEG group.

The mean total Ottawa bowel preparation scale were 8 and 5, respectively.

The research team noted that 15% of patients in the oral nutritional supplements group, and 35% of patients receiving PEG had an Ottawa bowel preparation scale score ≤4.

The team observed that oral nutritional supplements was better tolerated than PEG with more patients reporting acceptable taste, and fewer reporting difficulties with the intake and nausea.

Dr Gustafsson's team concludes, "For routine use, oral nutritional supplements with enema instead of traditional preparation for colonoscopy with PEG cannot be generally recommended."

Scand J Gastroenterol 2014: 49(4): 485-491
17 April 2014

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