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.

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 vs. 4L GoLytely®. Methods This is a retrospective endoscopic database analysis of ≥ 50 year old average-risk individuals with a normal screening colonoscopy at a community hospital and ambulatory endoscopy center. Data was extracted for the last four months when 4L GoLytely® was the preferred bowel purgative and the first 4 months when 238g MiraLAX® in 64 ounces Gatorade and four 5-mg bisacodyl tablets became the preferred purgative. All patients used PM-only dosing of bowel purgative. Results 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 to patients taking the GoLytely® preparation (93.3% vs. 89.3%, respectively; p = 0.048). However, when only 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 to patients with a fair cleansing [OR = 28.01; 95% CI: 13.96-56.19]. Conclusions The MiraLAX® + Gatorade + bisacodyl combination produces similar rates of excellent/good bowel cleansing as compared to GoLytely® in most average-risk individuals undergoing colonoscopy for CRC screening in a community setting.

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