Commonly used preparations for colonoscopy - Efficacy, tolerability and safety - A Canadian Association of Gastroenterology position paper

Sep 27, 2026

Review of bowel cleansing preparations for colonoscopy addresses efficacy, tolerability, and safety in Canada, prompted by growing procedure demand, introduction of newer regimens, and recent caution advisories. Randomized prospective trials evaluating common Canadian options were systematically assessed. Reviewed agents included PEG, sodium phosphate (NaP), magnesium citrate, and PSMC-containing preparations, with findings emphasizing the role of hydration to reduce side effects and improve cleansing.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

~~ SPECIAL ARTICLE ~~ | Commonly used preparations for colonoscopy: Efficacy, tolerability and safety – A Canadian Association of Gastroenterology position paper
Alan Barkun MD1,2, Naoki Chiba MD MSc3,4, Robert Enns MD5, Margaret Marcon MD6, Susan Natsheh MD7, Co Pham PharmD8, Dan Sadowski MD9, Stephen Vanner MD10 | | | --- | --- | | A Barkun, N Chiba, R Enns, et al. Commonly used preparations for colonoscopy: Efficacy, tolerability and safety – A Canadian Association of Gastroenterology position paper. Can J Gastroenterol 2006;20(11):699-710.
INTRODUCTION: The increased demand for colonoscopy, coupled with the introduction of new bowel cleansing preparations and recent caution advisories in Canada, has prompted a review of bowel preparations by the Canadian Association of Gastroenterology.
METHODS: The present review was conducted by the Clinical Affairs group of committees including the endoscopy, hepatobiliary/transplant, liaison, pediatrics, practice affairs and regional representation committees, along with the assistance of Canadian experts in the field. An effort was made to systematically assess randomized prospective trials evaluating commonly used bowel cleansing preparations in Canada.
RESULTS: Polyethylene glycol (PEG)-; sodium phosphate (NaP)-; magnesium citrate (Mg-citrate)-; and sodium picosulphate, citric acid and magnesium oxide (PSMC)-containing preparations were reviewed. Regimens of PEG 2 L with bisacodyl (10 mg to 20 mg) or Mg-citrate (296 mL) are as effective as standard PEG 4 L regimens, but are better tolerated. NaP preparations appear more effective and better tolerated than standard PEG solutions. PSMC has good efficacy and tolerability but head-to-head trials with NaP solutions remain few, and conclusions equivocal. Adequate hydration during preparation and up to the time of colonoscopy is critical in minimizing side effects and improving bowel cleansing in patients receiving NaP and PSMC preparations. All preparations may cause adverse events, including rare, serious outcomes. NaP should not be used in patients with cardiac or renal dysfunction (PEG solution is preferable in these patients), bowel obstruction or ascites, and caution should be exercised when used in patients with preexisting electrolyte disturbances, those taking medications that may affect electrolyte levels and elderly or debilitated patients. Health Canada’s recommended NaP dosing for most patients is two 45 mL doses 24 h apart. However, both safety and efficacy data on this dosing schedule are lacking. Many members of the Canadian Association of Gastroenterology expert panel administer both doses within 24 h, as studied in clinical trials, after careful one-on-one discussion of risks and benefits in carefully selected patients. Safety data on PSMC and combination preparations in North America are limited and clinicians are encouraged to keep abreast of developments in this area.
CONCLUSIONS: All four preparations reviewed provided effective bowel cleansing for colonoscopy in the majority of patients, with varying tolerability. Adequate hydration is essential in patients receiving the preparations.
Key Words: Colon preparation; Colonoscopy; Polyethylene glycol; Sodium phosphate | L’efficacité, la tolérabilité et l’innocuité de préparations de coloscopie courantes :
Un document de principes de l’Association canadienne de gastroentérologie
INTRODUCTION : La demande accrue de coloscopies, couplée à l’apparition de nouvelles préparations intestinales et de récentes mises en garde au Canada, a incité l’Association canadienne de gastroentérologie à analyser les préparations intestinales.
MÉTHODOLOGIE : Le groupe des comités des affaires cliniques aprocédé à la présente analyse, y compris les comités sur l’endoscopie, les troubles hépatobiliaires et les greffes, les représentants, la pédiatrie, les affaires de pratique et les représentants régionaux, avec l’aide d’experts canadiens dans le domaine. On s’est

FAQs

Which bowel cleansing preparations were evaluated for colonoscopy?

The review assessed polyethylene glycol (PEG), sodium phosphate (NaP), magnesium citrate, and sodium picosulphate, citric acid and magnesium oxide (PSMC)-containing preparations.

How do PEG 2 L regimens compare with standard PEG 4 L regimens?

PEG 2 L regimens combined with bisacodyl or magnesium citrate were reported as as effective as standard PEG 4 L regimens and better tolerated.

Why is hydration emphasized, and who should avoid NaP?

Adequate hydration during preparation and up to the time of colonoscopy is critical to minimize side effects and improve cleansing, and NaP should not be used in patients with cardiac or renal dysfunction, bowel obstruction, or ascites.

Sep 27, 2026

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