Bowel preparation

Two patterns of standardized colonoscopy preparation drugs were used at our facility. In patients without constipation, magnesium citrate (Magcorol^® P, Horii Pharmaceutical Ind., Ltd., Osaka, Japan) and PEG-ELS (Muben^® liquid state, Nihon Pharmaceutical Co., Tokyo, Japan) were administered. Patients were instructed to dissolve Magcorol^® P 50 g in water to a total volume of 180 mL and take it the night before colonoscopy and take 2 L of PEG-ELS in the morning before colonoscopy (“normal” method). For constipated patients, in addition to the above medications, sodium picosulfate hydrate (Laxoberon^® solution 0.75% 10 mL, Teijin Pharma, Ltd., Tokyo, Japan) was added the night before colonoscopy (“strong” method). In case of difficulty ingesting 2 L of PEG-ELS, 50 sodium phosphate (NaP) tablets (Visiclear^® combination tablet, ZERIA Pharmaceutical Co., Ltd., Tokyo, Japan) were used instead of PEG-ELS only for patients aged below 65 years old who did not have hypertension. No dietary restrictions were indicated on the day before the colonoscopy. In Japan, there are many facilities where nurses check the defecation status after preparation drug administration; and if there are still brown stools, enemas are additionally administered [24]. In our hospital, nurses in the endoscopy center presented the patients with example pictures of stool condition after preparation and asked whether their feces were clear. A saline (2% NaCl) enema (500 mL) was administered if preparation was inadequate.

Gastroenterologists interviewed the patient when prescribing preparation medication. In patients diagnosed with constipation, a “strong” preparation method was recommended. For patients with regular use of laxatives, we also recommended the “strong” method. In cases with concerns about large bowel obstruction, no preparation medication was prescribed, and colonoscopy was performed with enema only.