Attention - Change in Colonoscopy Prep Protocol

Recently I became aware that Osmoprep tablets are no longer available to be obtained as the manufacturer has discontinued production.

Therefore, when considering colonoscopy through SVMUC’s mobile services, a new colonic prep protocol will be needed. The new protocol is based on recommendations from several ACVIM sources (including 2021 ACVIM conference lecture).

Patient preparation. Withhold food for 24-48 hours – but maintain access to water. Administer two doses of a colonic electrolyte lavage solution (GoLYTELY which is Polyethylene glycol 3350 product, 20 ml/kg/dose given 4–6 hours apart orally – would recommend via NG Tube to lessen risk of aspiration) the day before procedure.

If not performing upper endoscopy would give IV metoclopramide at 0.5 mg/kg q 8 hours (to help improve gastric emptying and lessen chance for regurgitation/vomiting of golytely).

If performing combined upper and lower endoscopy would only give one dose of metoclopramide with first dose of GoLYTELY to lessen any interference with interpretation of gastric motility esophageal sphincter tone etc. The cleansing solution may be administered either by orogastric intubation or NG Tube (rarely will see patient ingest on own accord). Give warm water enema (20 ml/kg) after each GoLytely administration and the morning of the procedure (so at minimum 3 warm water enemas over the 24 hour 12-24 hour prep period). The golytely per an endoscopy book has little net absorption or secretion of fluid or electrolytes (so should not cause dehydration) and solution physically flushes feces and cleanses colonic mucosal surface as exits the GI tract – however to be on safe side would give SQF prior to going home to help maintain hydration in hopes creating best state for anesthesia.

If patient is not being prepped in 24 hour facility and going home the night after getting golytely – owner should be prepared for moderate to significant diarrhea that may or may not be controllable.