Residual Stool Research Articles

Missed Lesions and False-Positive Findings on Computed-Tomographic Colonography: a Controlled Prospective Analysis

The aim of the present study was to analyze the reasons for false findings on computed-tomographic (CT) colonography. A total of 100 consecutive CT colonography examinations were carried out before conventional colonoscopies scheduled on the same day. Before the study, an experienced radiologist received training in analyzing CT colonographies. The radiologists and endoscopists were blinded to each others' findings. The patients received standard polyethylene glycol bowel preparation and were scanned in the prone and supine positions using a helical CT scanner and commercially available software for image analysis. Each pair of examinations was later followed by an unblinded analysis, comparing the CT colonographies with video recordings of the conventional colonographies in order to determine the reasons for tumors being missed or false-positive diagnoses arising on CT colonography. Ninety polyps were detected in 41 patients. For patients with tumors > or = 5 mm and > or = 10 mm, the sensitivity was 67 % and 75 %, respectively, and the specificity was 84 % and 95 %, respectively. The most important reasons for the 38 false findings of tumors > or = 5 mm were perception errors (21 of 38) and misinterpretation of flat lesions in particular, including a high-grade dysplasia and a flat elevated Dukes A carcinoma. Residual stool was frequently the reason for misinterpreting lesions > or = 10 mm (four of 10). Perception errors were the main reason for false findings of lesions > or = 5 mm, including one flat malignant lesion. Residual stool caused four of 10 false findings for lesions > or = 10 mm. Reading CT colonographies requires a high level of expertise, and conventional colonography is still regarded as the gold standard for detecting colorectal lesions.

CT Colonography with Intravenous Contrast Material: Varied Appearances of Colorectal Carcinoma

Computed tomographic (CT) colonography is a noninvasive, rapidly evolving technique that has been shown in some studies to be comparable with conventional colonoscopy for the screening of colorectal cancer. Because colorectal cancer has a widely varying appearance at both endoscopy and CT colonography, familiarity with the gamut of morphologic appearances can help improve interpretation of the results. The addition of intravenous contrast material to CT colonography can aid differentiation of true colonic masses from pseudolesions such as residual stool and improves the depiction of enhancing masses that might otherwise be obscured by residual colonic fluid. In contrast to staging of most other tumors, staging of colorectal carcinoma depends more on the depth of tumor invasion than on the size of the primary mass. The diverse appearances of colorectal cancers at two- and three-dimensional CT colonography include sessile, annular, ulcerated, necrotic, mucinous, invasive, and noninvasive lesions. Imaging pitfalls that can simulate or obscure neoplasms are retained fecal material or fluid, incomplete distention, and advanced diverticulosis.

Comparison of Two Dosing Regimens of Liquid Sodium Phosphate Against a Low Dose PEG Regimen

Purpose: To compare the quality of preparation (prep), tolerability and acceptability of two dosing regimens of oral sodium phosphate (NaP) with a low dose regimen of PEG solution + Bisacodyl tablets for patients undergoing elective colonoscopy. Methods: Commercially available oral NaP, Unflavored Fleet® Phospho-soda® (C. B. Fleet Co., Inc.) and 2 L PEG 3350 solution with 4, 5 mg tablets Bisacodyl [HalfLytely® kit] (Braintree Laboratories) (PEG-L), were evaluated. NaP was administered as two doses, one the evening prior and second in the morning of the procedure. Two dosing regimens of NaP were used: a) 45 mL NaP in the evening, 45 mL in the morning of the exam (NaP-S); or b) 45 mL NaP evening, 30 mL morning (NaP-L). All doses of NaP were diluted with 12 fl.oz. of a non-sugar lemonade flavored beverage; subjects were allowed a low-residue lunch diet regimen the day before the colonoscopy. The PEG-L subjects all followed manufacturer's prep instructions (4 Bisacodyl tablets at noon, 2 L PEG following the first bowel movement; clear liquids entire day before until after the exam). Subjects were balanced by gender and randomized to the treatment groups. Physicians, blinded to the medication, rated the quality of the prep on a Likert scale (Poor, Fair, Good and Excellent). A residual stool score (RSS, range 0 – 12) was based on the sum of 3 prep quality components: stool amount, consistency and% wall visualized, scored on a 0–4 scale (0 = best to 4 = worst). Subjects rated 12 common side effects on a 4-level scale, and rated acceptability items on a 5-level scale. Results: Mean age of 55 years was similar in all 3 groups. Bowel cleansing rated by physicians was superior for NaP compared to PEG-L (p < 0.001), but not different between NaP doses (p = 0.644). RSS scores showed the same findings (p = 0.002). Side effect reports were similar among groups. There were no differences in ease of drinking or taste. Willingness to retake the regimen was significantly different (p = 0.019), with percent positive responses 95, 88, 73 for NaP-L, NaP-S, PEG-L. Conclusions: Better prep was achieved with both NaP regimens over PEG-L. Subjects reported a higher willingness to repeat NaP preps. All preps had similar profiles of tolerability and acceptability.Table: No Caption available.

CT colonography with fecal tagging after incomplete colonoscopy

The objective of this study was to evaluate dietary fecal tagging (FT) as a cleansing method prior to CT colonography (CTC) in patients with incomplete conventional colonoscopy (CC). After written informed consent was obtained, 24 patients had standard colonoscopic preparation (ScCl), and 25 patients had FT as cleansing method. Segmental distention, fluid levels, fecal residues, tagged appearance of fluid levels, and residual stool were evaluated. Mann-Whitney U test was used to test for significant differences between FT and ScCl groups. Compared with ScCl, FT improved distention (p=0.001), reduced the amount of fluid (p=0.043), but suffered from residual stool (p=0.046). A clear correlation was found between distention and fluid. No differences were found in stool size between FT and ScCl. FT showed a good labeling of fecal residues, and acceptable labeling of fluid levels. Compared with ScCl, FT reduces fluid, favors distention, but suffers from fecal residues. The tagged nature of these residues, however, allows differentiation from polyps.

Magnetic Resonance Colonography: Comparison of Contrast-Enhanced Three-Dimensional Vibe With Two-Dimensional FISP Sequences

The purpose of this study was to compare a dark-lumen magnetic resonance colonography (MRC) approach with a True FISP-based bright-lumen technique concerning presence of artifacts and the detection rate of colorectal pathologies. Thirty-seven patients with suspected colorectal lesions were included in this trial. The colon was filled with 2500 mL of tap water. Two-dimensional True FISP datasets as well as T1-weighted GRE sequences (pre- and post intravenous contrast) were acquired. The detection rate of colorectal masses and inflammatory lesions was determined for both techniques separately. Besides, image quality was assessed. All patients underwent conventional colonoscopy as the standard of reference. By means of dark-lumen MRC datasets, all polyps >5 mm were correctly diagnosed, whereas 4 polyps <5 mm were missed. Sensitivity of dark-lumen MRC amounted to 78.9%. There were no false-positive results: residual stool could correctly be differentiated from colorectal masses. The True FISP-based bright-lumen MRC, however, failed to detect 2 additional polyps resulting in a sensitivity of 68.4%. Furthermore, bright-lumen MRC led to false-positive results in 5 patients. Both techniques visualized inflammatory bowel disease in 5 patients. However, image quality of True FISP was rated superior to that of dark-lumen MRC. Dark-lumen MRC proved to be superior over bright-lumen MRC regarding the detection of colorectal masses. However, True FISP imaging can turn out to be helpful as a result of high image quality and motion insensitivity.

CT colonography (virtual colonoscopy) for primary colorectal screening: challenges facing clinical implementation

Computed tomographic colonography (CTC), also referred to as virtual colonoscopy, is a minimally invasive test for the detection of colorectal polyps. Although its initial performance characteristics for evaluating lowprevalence populations were rather disappointing [1, 2], a larger multicenter trial in asymptomatic adults subsequently showed that CTC has the potential to be an effective primary screening tool [3]. Key features in the latter study that help explain this improved performance include the use of the three-dimensional endoluminal display for primary polyp detection, oral contrast for tagging of residual fluid and stool, segmental unblinding of CTC results at optical colonoscopy (OC), and use of only multidetector CT scanners [3]. As we await further validation of this rapidly evolving technique, actual clinical implementation of primary CTC screening should proceed without delay by those who are currently able to achieve an acceptable accuracy. The need for immediate action is self-evident, as far too many people are dying from a disease that could have been prevented by effective routine screening in more than 95% of cases [4]. There are many important challenges that are likely to be encountered as CTC screening transitions from the realm of research to daily clinical practice (Table 1). This update focuses primarily on three specific issues: (a) development of a logical diagnostic algorithm for CTC screening, (b) identifying the most appropriate group of patients to be screened by CTC, and (c) establishing a mutually beneficial working relationship with gastroenterology. Additional challenges and issues that are also important but are not covered in report include demonstrating the relative cost effectiveness of CTC screening, reimbursement by third-party payers, dedicated training of radiologists, and establishment of standard practice guidelines and accreditation. In the end, I believe that none of these challenges will prove to be insurmountable.

Low volume bowel preparation for colonoscopy: randomized, endoscopist-blinded trial of liquid sodium phosphate versus tablet sodium phosphate

Objective The aim of this study was to compare the colon-cleansing effectiveness, ease of consumption, and side effect profiles of two commercially available preparations of sodium phosphate: liquid Fleet Phospho-soda and Visicol tablets. Methods Outpatients undergoing elective colonoscopy were sequentially randomized to one of two preparation groups: liquid: 45 ml at 7:00 PM, 45 ml 3 h before colonoscopy; or tablet: 20 tablets at 7:00 PM, 20 tablets 3–5 h before colonoscopy. Subjects rated preparation tolerability on a 5-point Likert scale. A Residual Stool Score was calculated for each subject based on the amount of stool, consistency of residual stool, and percent of bowel visualized (range 0–11, 0 = best). The endoscopists were blinded to the preparation used. Results A total of 101 subjects were enrolled (43 male, 58 female, mean age 58.2 yr). The groups were similar in age and indications for colonoscopy. Overall, bowel cleansing was rated “Excellent” or “Good” in 92% of liquid preparation subjects, compared with 74% of tablet preparation subjects ( p = 0.03). Subjects in the liquid group demonstrated significantly less residual stool than did tablet subjects (Residual Stool Scores: liquid 1.3 ± 1.2 vs tablet 1.9 ± 1.5, p < 0.05). Subjects rated the liquid preparation easier to swallow ( p < 0.005) and more convenient to take ( p < 0.005) than tablets. Among liquid subjects, 45 of 50 reported a willingness to take their preparation for future colonoscopies, compared with 36 of 49 who took tablet sodium phosphate ( p < 0.04). Conclusions Liquid sodium phosphate is better tolerated and more effective at colon cleansing when compared with sodium phosphate in tablet form.

3-D Virtual Colonoscopy: A Breakthrough for Colon Cancer Screening?

Results from previous studies of computed tomographic (CT) virtual colonoscopy for colon cancer screening have varied widely, and recent results in populations with low prevalences of colorectal cancer have been poor (Journal Watch Gastroenterology Sep 9 2003 ). In this study, investigators at 3 military hospitals performed same-day virtual and conventional screening colonoscopy in 1233 asymptomatic, average-risk adults. Whereas most previous researchers used 2-dimensional techniques, these radiologists relied on 3-D fly-through images for initial detection of polyps with virtual colonoscopy; in addition, barium contrast material was used during bowel preparation to tag residual fluid and stool. To verify inconsistencies between the …

Fecal tagging: MR colonography without colonic cleansing.

Colorectal cancer, mostly arising (>90%) from preexisting adenomatous polyps, continues to be the second leading cause of cancer death. Magnetic resonance colonography (MRC) permits accurate detection of colonic polyps with a diameter larger than 10 mm. Because residual colonic stool cannot be differentiated from polyps, MRC requires a clean colon. However, the rigors associated with colonic cleansing considerably reduce patient acceptance. The need for colonic cleansing could be eliminated, if stool were to acquire a signal intensity different from polyps and identical to the enema used to fill and distend the colon. In principle, there are two approaches to this concept of fecal tagging: dark polyps surrounded by bright stool and a bright enema, and bright polyps surrounded by dark stool and a dark enema. The first approach has been evaluated with some success. Gadolinium (Gd)-DOTA was administered as an oral contrast agent with meals preceding MRC based on the administration of a Gd-based enema. The high cost of Gd-based contrast has limited the clinical utility of this technique. In the second approach patients are provided with barium as an oral fecal tagging agent to render stool dark, and barium for the enema is used to distend the colon during MRC. The colonic wall and polyps arising from it can be made visible after intravenous administration of Gd-based extracellular contrast. This method provides sufficient contrast between the darkened colonic lumen and the brightly enhanced colonic wall to permit virtual endoscopic rendering. Preliminary results showed an exact correlation with findings of conventional endoscopy and surgery. Fecal tagging obviates bowel cleansing and therefore should enhance patient acceptance for MR colonoscopy. Barium as the tagging agent is promising because it is inexpensive, commercially available, and characterized by an excellent safety profile.

CT colonography: examination prerequisites.

CT colonography is likely to play an important role in colorectal cancer screening. The ability of this new technique to detect colorectal polyps and cancer is predicated on an optimally cleansed and distended colon. Whereas the most common reported colonic cleansing regimen employed for CT colonography is polyethylene glycol lavage solution, saline cathartics such as sodium phosphate and magnesium citrate offer the advantage of a drier cleansed colon. Positive labeling of residual stool and fluid combined with electronic substraction of tagged material is under investigation. This new technique would eliminate purgative bowel cleansing and increase patient acceptance of CT colonography. Colonic distention is easily and reliably achieved with atmospheric air, although carbon dioxide is being evaluated as a more comfortable alternative. The use of antispasmodics for CT colonography is controversial. Glucagon is no longer used at centers where a clear benefit has not been found. Intravenous contrast may be useful in a specific subset of patients undergoing CT colonography, although it is doubtful that it will be used routinely for CT colonography.

Bowel wall visualisation at CT colonography

To evaluate the quality of bowel wall visualisation at CT colonography and the impact of examination in the supine and prone positions. After bowel preparation, 111 patients underwent CT colonography. Air distension, degree of fluid redistribution with change in body position (supine and prone), influence of residual stool on bowel wall assessability, and quality of overall colon visualisation were evaluated using scales. Thirty of 110 patients (27%) had complete overall visualisation of the colon wall and 52 (47%) had subtotal visualisation of a limited part of the colon. The entire colon was more often air-filled in the prone position (46%) than in the supine position (18%). Joint review of supine and prone data showed that for all colon segments, except the sigmoid (86%), > or =95% of the patients had complete air filling. All patients had residual fluid. In 75% to 99%, depending on segment, fluid did not interfere with the bowel wall visualisation in the combined evaluation of supine and prone data sets. Thirty-one patients had residual stool with potential negative influence on polyp detection. The colon wall was completely, or almost completely, visualised in 75% of the patients, and examination in the supine and prone positions was necessary for complete visualisation.

Bowel wall visualisation at CT colonography

To evaluate the quality of bowel wall visualisation at CT colonography and the impact of examination in the supine and prone positions. After bowel preparation, 111 patients underwent CT colonography. Air distension, degree of fluid redistribution with change in body position (supine and prone), influence of residual stool on bowel wall assessability, and quality of overall colon visualisation were evaluated using scales. Thirty of 110 patients (27%) had complete overall visualisation of the colon wall and 52 (47%) had subtotal visualisation of a limited part of the colon. The entire colon was more often air-filled in the prone position (46%) than in the supine position (18%). Joint review of supine and prone data showed that for all colon segments, except the sigmoid (86%), > or =95% of the patients had complete air filling. All patients had residual fluid. In 75% to 99%, depending on segment, fluid did not interfere with the bowel wall visualisation in the combined evaluation of supine and prone data sets. Thirty-one patients had residual stool with potential negative influence on polyp detection. The colon wall was completely, or almost completely, visualised in 75% of the patients, and examination in the supine and prone positions was necessary for complete visualisation.

Decreased efficacy of polyethylene glycol lavage solution (Golytely) in the preparation of diabetic patients for outpatient colonoscopy: a prospective and blinded study

OBJECTIVES: The aim of the present study was to compare, in a prospective and blinded fashion, the efficacy of 6 L of polyethylene glycol–based lavage solution (Golytely) administered on an outpatient basis in diabetic versus nondiabetic patients. METHODS: A total of 54 consecutive nondiabetic and 45 consecutive diabetic patients requiring outpatient colonoscopy underwent colonic cleansing by drinking 6 L of Golytely the evening before the procedure. The entire procedure, from rectum to cecum, was videotaped and coded for later review by the Chief of Endoscopy who was blinded to the identity and medical history of the patients. The primary outcome measure was the quality of the preparation score, numerically rated on a 14-point scale (0–13) based on the surface area of the mucosa that could be examined and the consistency of the residual stool. RESULTS: There was a significant difference in the quality ratings for the bowel preparations, with an overall superior preparation in the nondiabetic group (2.4 ± 1.6 vs 5.4 ± 3.1, p < 0.001). A total of 97% of the nondiabetic patients had a preparation rated as good or better, compared with only 62% of the diabetic patients ( p < 0.001). Preparations rated as poor or futile, necessitating repeat colonoscopy, occurred in no nondiabetic but in 9% of diabetic patients ( p < 0.01). Within the diabetic group, there was no significant difference in bowel preparation scores between those patients aged >70 yr and those <70 yr, those requiring and those not requiring insulin, those with Hb A1c values >8% and those with values <8%, and those with and without peripheral neuropathy. CONCLUSION: We conclude that diabetic patients (irrespective of insulin use, diabetic control, or diabetic neuropathy) have a significantly poorer response to a 6-L Golytely preparation than do nondiabetic patients.

3326 Phospho-soda vs.peg lavage as pre-endoscopic preparation for colonoscopy: a randomized trial.

We have previously demonstrated in a pilot study that phospho-soda is equivalent to PEG lavage in colon cleansing effectiveness (Am J Gastro 1998;93:A1684). PURPOSE: To compare the colon cleansing effectiveness, ease of consumption, and metabolic effects of phospho-soda (PS) and PEG lavage given as colonoscopic preparation. METHODS: Outpatients undergoing elective colonoscopy were randomized to receive either a phospho-soda prep kit (PS 45cc at 6pm + bisacodyl 3 P.O. hs + bisacodyl enema am) or PEG lavage (4L at 4pm) prior to colonoscopy. Subjects with creatinine >2.0, cardiac disease, cirrhosis, or pregnancy were excluded. Subjects completed a questionnaire rating prep tolerability. A side effect score was calculated for each subject (range 0-21, 0 = best). Chemistry profiles were performed before the prep and on the morning of the procedure. The endoscopist was blinded to the prep used. A global prep assessment was recorded for each subject based on the amount and consistency of residual stool {range = 1 (poor) to 5 (excellent)}. RESULTS: 167 subjects (74M, 93F, mean age 59.9 yr.) were enrolled. The two groups were similar in age, sex distribution, and indications for colonoscopy. 64/82 (78%) phospho-soda preps were ranked very good or excellent vs. 63/85 (74%) PEG preps (p=NS). Among 42 PS subjects who had taken PEG during a previous colonoscopy, 38 (90%) ranked PS as more tolerable than PEG. Data shown [see table below] are mean ± SE. CONCLUSIONS: Phospho-soda preps are equally effective and better tolerated when compared to PEG lavage for pre-endoscopic colon cleansing. Increases in serum phosphorous with phospho-soda are small and are likely to be clinically insignificant. Phospho-soda is an appropriate alternative to PEG lavage for the preparation of healthy patients undergoing colonoscopy.

Effect of radiotherapy on anorectal function in patients with cervical cancer.

The acute and long-term effects of pelvic radiation on defecation were studied. Anorectal function was assessed based on manometry and subjective symptoms in 31 patients with cervical cancer treated by radiotherapy alone. Sixteen of 31 patients were examined periodically before, during, and after radiotherapy (early group). Fifteen others were examined more than six months after completion of radiotherapy (late group). One-third of patients in both groups had symptoms, mainly diarrhea and increased stool frequency. Patients in the late group also suffered from disturbed gas-stool discrimination, urgency, a sense of residual stool, and soiling. Anal canal resting pressure was significantly higher after radiotherapy (47 +/- 15.5 mmHg) than before radiotherapy (36.3 +/- 12.5 mmHg; P < 0.05). The maximum tolerable volume decreased with radiation, from 163.3 +/- 45 before to 119.2 +/- 41.4 ml during, 112.7 +/- 36.6 ml immediately after, and 94.6 +/- 34.4 ml in the late group (P < 0.01). Rectal compliance also decreased over time and was lower in the early group (before, 5.7 +/- 1.3 ml/mmHg; P < 0.01; during, 4.6 +/- 2.2 ml/mmHg, P < 0.01; after, 3.7 +/- 1.4 ml/mmHg; P < 0.05) than the late group (2.1 +/- 1.5 ml/mmHg) and lower before than after in the early group (P < 0.01). Although rectal pressure initiating continuous desire to defecate did not change, the maximum tolerable pressure was significantly higher in the late group (81 +/- 19.5 mmHg) than during (59 +/- 16.8 mmHg) or after (59.9 +/- 16.9 mmHg) radiotherapy in the early group (P < 0.05). Radiation reduces the capacity of the rectal reservoir, even in asymptomatic patients. These changes develop during radiotherapy and progress over time.

Bowel Preparation Before Colonoscopy in the Pediatric Patient: A Randomized Study

Flexible fiberoptic colonoscopy is an established diagnostic procedure in the pediatric patient. The approach to the pediatric patient is, however, different from the approach to adults. Bowel preparation must be geared to the age, size, and clinical status of the patient. An effective, palatable, standardized bowel preparation has not been determined for the child undergoing a colonoscopy. This study systematically evaluated three components of the bowel preparation--cathartics, diet, and enema use. The bowel preparation of 140 children undergoing colonoscopy at The Children's Hospital of Philadelphia was evaluated. The effectiveness of the bowel preparation was evaluated by direct visualization during the colonoscopy as to the amount and consistency of the residual stool in the colon. Parents were interviewed to determine adherence to the instructions including tolerance of diet, cathartics, and enema administration. Equipment maintenance was also monitored. An effective bowel preparation was achieved in all groups. As a result of this study, the Division of Gastroenterology and Nutrition at The Children's Hospital of Philadelphia now uses a less restrictive diet, one enema, and X-Prep to achieve effective bowel preparation for colonoscopy.

Preparation of the colon for single- and double-contrast barium enema examination: a simplified method.

A commercially available prepackaged liquid diet was prescribed to 112 patients to use in combination with laxatives in a 1-day preparation regimen before single- and double-contrast barium enema examination. Cleansing enemas were not performed before the examination. Colon radiographs were evaluated with regard to amount of residual stool, mucosal detail, coating, and overall quality. Results were excellent in 92% (103 of 112) of patients and fair in 5% (six of 112). Cleansing enemas can be avoided through use of this preparation protocol.

Addition of enemas to oral lavage preparation for colonoscopy is not necessary

To evaluate whether the addition of enemas to oral electrolyte lavage is helpful for colonoscopic preparation, we conducted a prospective, randomized, observer-blinded trial to compare oral lavage plus enemas with oral lavage alone. The quality of preparation, mucosal visualization, and the volume of retained colonic fluid did not differ between the two groups. Twenty-two percent of the patients in the group who received oral lavage plus enemas compared with 12% of the patients in the group that only received oral lavage stated that they would refuse to repeat the preparation for future colonoscopic examination. Seventeen percent of the patients in the group that received oral lavage plus enemas demonstrated anorectal trauma or inflammation compared with only 5% in the group that received oral lavage alone (p = 0.09). These results indicate that the addition of enemas to oral lavage preparation for colonoscopic evaluation cannot be routinely recommended. However, enemas may be considered on an individual basis in the occasional patient unable to consume the complete oral lavage or in whom residual stool is found during colonoscopic evaluation after oral lavage preparation.

Improvement of oral colonic lavage with supplemental simethicone

We have noted that colons of patients prepared for colonoscopy with Golytely, a nonabsorbable electrolyte lavage solution, frequently contain foam which may obscure small mucosal lesions. Therefore, a randomized, blinded controlled trial was performed to determine the prevalence of Golytely-induced foam and the effect of supplemental simethicone in decreasing the prevalence of foam. Foam was present in 32% of colons prepared with Golytely alone but in none of the colons prepared with Golytely supplemented with simethicone. In addition, only 5% of colons prepared with supplemental simethicone had residual stool noted at the time of colonoscopy, a significant improvement over the 39% prevalence of residual stool in colons prepared with Golytely alone. Addition of simethicone to Golytely lavage decreases the prevalence of colonic foam and residual stool.

A randomized blinded clinical trial of a rapid colonic lavage solution (Golytely) compared with standard preparation for colonoscopy and barium enema

The efficacy and safety of the new colonic lavage solution, Golytely (an electrolyte-polyethylene glycol solution), was compared with standard 2- and 3- day bowel preparations in a randomized blinded study of patients undergoing colonoscopy and barium enema examination. Side effects, patient preference, and quality of examinations were monitored. Colonoscopy was scored by colonic segment for type of residual stool and percentage of bowel wall visualized. Barium enema was graded by stool particle size in the least clean segment. For colonoscopy, preparation with Golytely allowed better visualization of colonic mucosa (p < 0.002) due to less retained stool (p < 0.002), produced more optimal exams (p < 0.002), and required less time to reach the cecum (p < 0.05). Furthermore, it was preferred by patients, required less than 5 h preparation time, and caused no notable side effects. For barium enema, no significant difference existed between preparations. We conclude that Golytely is effective for barium enema examination and is the preparation of choice for colonoscopy.