MiraLAX-Gatorade bowel prep versus GoLytely before screening colonoscopy: an endoscopic database study in a community hospital.

BACKGROUND: Polyethylene glycol-3350 without electrolytes (MiraLAX; Schering-Plough Healthcare Products Inc.)+a carbohydrate-electrolyte solution (Gatorade; PepsiCo Inc.)+bisacodyl is frequently used for bowel cleansing, although limited data quantifies its efficacy and safety. No prior studies have assessed this in a community setting or with PM-only dosing, which is still used frequently. AIM: To compare the frequency of excellent/good/fair/poor bowel cleansing with PM-only dosing of MiraLAX-Gatorade-bisacodyl versus 4-liter GoLytely. METHODS: This is a retrospective endoscopic database analysis of 50 years and older average-risk individuals with a normal screening colonoscopy at a community hospital and ambulatory endoscopy center. Data were extracted for the last 4 months when 4-liter GoLytely was the preferred bowel purgative and the first 4 months when 238-g MiraLAX in 64-ounce Gatorade and four 5-mg bisacodyl tablets became the preferred purgative. All patients used PM-only dosing of bowel purgative. RESULTS: A total of 778 subjects [GoLytely (n=395) vs. MiraLAX+Gatorade+bisacodyl (n=383)] were identified. Patients who took the MiraLAX bowel preparation were more likely to achieve an excellent/good bowel cleansing compared with patients taking the GoLytely preparation (93.3% vs. 89.3%, respectively; P=0.048). However, when only American Society of Anesthesiology (ASA) class I patients are studied, there was no difference in frequency of excellent/good bowel cleansing (91.1% vs 93.6%, respectively; P=0.498). No serious adverse events were identified. An excellent/good bowel cleansing was strongly associated with a recommendation for repeat colonoscopy in 10 years compared with patients with a fair cleansing (odds ratio=28.01; 95% confidence interval, 13.96-56.19). CONCLUSIONS: The MiraLAX+Gatorade+bisacodyl combination produces similar rates of excellent/good bowel cleansing as compared with GoLytely in most average-risk individuals undergoing colonoscopy for colorectal screening in a community setting.

Giant ileal inflammatory fibroid polyp causing small bowel obstruction: a case report and review of the literature.

INTRODUCTION: There are several types of small bowel pathology that can lead to small bowel obstruction or intussusception. The etiology causing small bowel obstruction varies by age. Benign disease is the typical cause in children and adolescents while malignant or adhesive disease is far more common in older patients. Although cases of adult intussusception caused by benign processes are rare, there are reports of inflammatory fibroid polyps causing adult intussusception of the terminal ileum published in the literature. CASE PRESENTATION: We present the case of a 70-year-old man with a multiple year history of intermittent episodes of bowel obstruction who was found to have a giant ileal inflammatory fibroid polyp causing intermittent small bowel obstruction. The patient underwent operative intervention and has now been symptom-free for three years. CONCLUSION: Small bowel lesions include both malignant and benign etiologies. The malignant etiologies include adenocarcinoma, carcinoid or lymphoma while benign lesions are typically lipomas, inflammatory polyps or adenomas. Inflammatory fibroid polyps are rare, benign lesions that can occur anywhere within the gastrointestinal tract. They are typically an incidental finding, but on rare occasions have been presented as the source of intussusception or obstruction.