BOWEL CLEANSING WITH SODIUM-PHOSPHATE

The well established bowel cleansing method using a polyethylene glyco l-based solution (Fordtran) is limited by the necessity of large volum e intake, which proves difficult for many patients. Therefore, a new m ethod using small volumes (2x90 ml) of oral sodium phosphate is employ ed more and more frequently. Its only disadvantage is the occurrence o f considerable nausea or occasional vomiting in about 25% of patients. To ascertain whether nausea could be reduced, 426 patients were given an antiemetic (ondansetron, metoclopramide, cisapride) or placebo on a randomized, double-blind basis, one hour before sodium phosphate int ake. Results: sodium phosphate was well tolerated in 69.2% of the pati ents on placebo, 73.6% on cisapride, 76.5% on metoclopramide and 80.4% on ondansetron. Taking all four groups together, male patients exhibi ted much better tolerance (86.1%) than females (66.1%). Severe nausea and/or emesis was noted in 22.4% of patients on placebo, 21.7% on cisa pride, 17% on metoclopramide and 14% on ondansetron. In over 90% of pa tients colon cleansing was rated as good to very good. This was largel y independent of the severity of nausea. 129 patients who had undergon e former polyethylene glycol-based lavage judged sodium phosphate to b e more tolerable and easier to complete. Considering known contraindic ations (symptomatic congestive heart failure and/or renal failure), no serious adverse event was noted in any of the 426 patients investigat ed. In accordance with several recent studies, we consider sodium phos phate solution at present the procedure of choice for colon cleansing. Compared to Fordtran, patient acceptance is far better and cleansing quality superior. Routine antiemetic comedication for reducing possibl e nausea/vomiting is not worthwhile. On the other hand, this study con firms our former impression of enhanced colon cleansing after administ ration of an additional mild laxative before sodium phosphate, without interfering with patient acceptance.