Single Center Comparison of 4 FDA Approved, Commercially Available Bowel Purgatives for Colonoscopy

We will randomize 300 consecutive patients undergoing colonoscopy for screening or surveillance purposes to receive one of four bowel purgatives. These purgatives include

1. Split dose 4 liter polyethylene glycol with electrolytes (PEG+E): Brand name GoLytely
2. Split dose 2 liter polyethylene glycol with ascorbic acid (PEG+Asc): Brand name: MoviPrep
3. Split dose sodium picosulfate, magnesium oxide, and anhydrous citric acid (P+MC): Brand name Prepopik
4. Split dose sodium sulfate, magnesium sulfate, and potassium sulfate solution (sulfate): Brand name Suprep

• PEG+E (Drug), also known as Golytely: Split dose 4 liter polyethylene glycol with electrolytes
• PEG+Asc (Drug), also known as MoviPrep: Split dose 2 liter polyethylene glycol with ascorbic acid
• P+MC (Drug), also known as Suprep: Split dose sodium picosulfate, magnesium oxide, and anhydrous citric acid
• sulfate (Drug), also known as Prepopik: Split dose sodium sulfate, magnesium sulfate, and potassium sulfate solution

Primary outcomes

• Efficacy of bowel cleansing according to the Boston Bowel Preparation Score (BPPS) [Patient outcome will be assessed at the time of the colonoscopy by the performing physician and ducomentation of this outcome will occur within 24 hours of the procedure]

Secondary outcomes

• Patient tolerability and satisfaction [Outcome of satisfaction will be assessed on a single survey that the patient will provide the day of their colonoscopy and will be recorded by study personnel up to 30 days thereafter]: Will be assessed using a previously studied satisfaction questionnaire (7 items)

Sex: All, ages: 18 Years to 90 Years

Inclusion Criteria:

1. Age 18 years or greater
2. Ability to understand and complete questionnaires
3. Ability to speak and read English
4. Willingness to participate in study
5. Colonoscopy is being performed for routine screening (i.e. no prior personal history of polyps or cancer) or surveillance (i.e. follow up for a personal history of polyps) purposes

Exclusion Criteria:

1. Previous bowel resection of any kind (small or large bowel)
2. End stage renal disease (ESRD)
3. Contraindication to bowel purgative
4. Necessity for inpatient admission to receive bowel preparation for any reason
5. Currently taking any narcotic/opiate pain or anticholinergic medication (since these may predispose to higher colon stool burden at baseline)
6. Currently taking stool softeners (e.g. Miralax, Amitiza, Linzess, lactulose) or stimulant laxatives (e.g. Dulcolax)
7. Subject did not follow appropriate dosing instructions for bowel purgative
8. Colonoscopy is being performed to evaluate a clinical symptom such as rectal bleeding, constipation, abdominal pain, or diarrhea
9. History of colon polyposis syndrome
10. Personal history of inflammatory bowel disease
11. History of inadequate colon preparation on any prior colonoscopies
12. Patient is pregnant