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119 MUCOSAL ABNORMALITIES AFTER PICO-SALAX BOWEL PREPARATION M Curley, D Sheppard INTRODUCTION: The Oral Fleet (sodium phosphate) bowel preparation was the first low volume purgative introduced for colonoscopy preparation. However, concerns emerged regarding safety in the elderly, and in patients at risk for CHF, hyperphosphatemia, and renal failure. In addition, rectal and colonic mucosal abnormalities associated with this bowel preparation were reported within the medical literature. An alternative, Pico-salax (sodium picosulfate/magnesium citrate), has recently been introduced. The purpose of this report is to present a case series of abnormalities likely secondary to this new preparation.
Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia
METHODS: We have collected a series of 6 cases in which mucosal abnormalities were found during colonoscopy after Pico-salax administration between January and August in 2006. Demographic data, indications for endoscopy, and medication history was collected for all patients. Photos and biopsies were taken in each case. A literature search was performed looking for an association between Pico-salax and mucosal abnormalities.
RESULTS: Confounding medications such as NSAIDS were ruled out in all patients. There were 3 males and 3 females with ages ranging from 23 to 60. The mucosal lesions resembled Crohn's ulcers in the terminal ileum and ileocecal valve. No abnormalities were seen on histopathologic examination. Our literature search did not find any previous documented association between Pico-salax and mucosal abnormalities.
DISCUSSION: This is the first case series describing mucosal lesions with Pico-salax. The lesions resemble Crohn's ulcers but lack evidence of chronic inflammatory changes on microscopic examination. We suggest endoscopists should use caution when using Pico-salax prior to colonoscopy for chronic diarrhea or other cases when inflammatory bowel disease is on the differential diagnosis. An objective comparison with randomization of preparations would be beneficial to prospectively analyze this issue.