Bowel Preparations: A Review for Community Pharmacists

Diana Chang, PharmD; Kevin Van, PharmD; Janette D. Lie, PharmD, BCACP; Jason P. Smith, PharmD; Kristie N. Tu, PharmD, BCPS, CGP

Disclosures

US Pharmacist. 2013;38(12):30-34. 

In This Article

Abstract and Introduction

Abstract

According to the U.S. Preventive Services Task Force, endoscopic screening for colorectal cancer has the potential to save thousands of lives each year. To maximize the diagnostic accuracy of a colonoscopy, it is crucial that the patient be prepared for the screening procedure. Two factors limiting the success of colonoscopy preparations are patient compliance and tolerability. Bowel preparations currently available for colonoscopy include compounds such as polyethylene glycol and sodium phosphate. Despite the emergence of newer alternatives, there is still no ideal preparation for colonoscopy. Community pharmacists can educate patients, address their concerns, and offer them individualized recommendations in order to improve the rates of successful bowel cleansing for colonoscopy.

Introduction

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States and the third most common cancer in both men and women.[1] The 5-year survival rate for patients whose CRC is diagnosed early (stage I) is greater than 90%, supporting the importance of early detection in reducing mortality.[2]

The U.S. Preventive Services Task Force has stated that endoscopic screening for CRC can potentially save thousands of lives annually.[3] It is essential, therefore, that patients be prepared for their screening procedure in order to maximize its diagnostic accuracy. According to the American Society for Gastrointestinal Endoscopy, colonoscopy is considered the gold standard for CRC screening.[4] Inadequate bowel cleansing is responsible for nearly one-third of incomplete procedures, resulting in a reduced rate of polyp and adenoma detection.[5] The accuracy of colonoscopy results relies heavily upon the selection of an appropriate bowel-preparation regimen, along with strict adherence to administration. This review will address the various bowel preparations used for colonoscopy and identify strategies for improving patient compliance and tolerability, two factors that limit the success of bowel preparations.

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