Yoga and Bolus Lukewarm Saline as Rapid Colonoscopy Preparation

• Efficacy of large bowel cleansing as assessed by the physician performing the colonoscopy [ Time Frame: Upto 24 weeks ] [ Designated as safety issue: No ]
  The evaluation involved the rating of six anatomical segments of the colon (rectum, sigmoid, descending colon, transverse colon, ascending colon and cecum) on a 5 point scale. Aggregating the segmental scores resulted in overall scores. The rating scale was validated by 4 gastroenterologists and 3 gastroenterology fellows with good correlation. The same scale was used successfully in pilot study.
  
  

• Subjective grading by all study patients on palatability of the large bowel preparation treatment [ Time Frame: Upto 24 weeks ] [ Designated as safety issue: No ]
  Patients completed a symptom questionnaire where they rated solution palatability of their assigned prep on a 1-5 Liekert scale.
  
  
• Subjective grading by patients on willingness to repeat the large bowel preparation. [ Time Frame: Upto 24 weeks ] [ Designated as safety issue: No ]
  Patients completed a symptom questionnaire where they rated willingness to repeat the preps on a 1-5 Liekert scale.
  
  
• Patient-reported adverse events. [ Time Frame: Upto 24 weeks ] [ Designated as safety issue: Yes ]
  Patients from both groups reported adverse events in a symptom questionnaire.
  
  
• Total preparation time [ Time Frame: Upto 24 weeks ] [ Designated as safety issue: No ]
  Patients in both groups were provided with a questionnaire to record the total time required from start of assigned prep to completion of the prep.
  
  

Effective large bowel cleansing prior to colonoscopy is still not achieved in all cases that undergo the procedure. The use of balanced electrolyte-polyethylene glycol (PEG) solution have improved the cleansing results and shortened the time needed for preparing the bowel. The problem with using PEG solution alone is the relatively large volume of the solution that the patients need to drink. The recommendation is to drink the solution until diarrhea fluid is clear and often 4 L or more is needed. Many patients refuse to drink the sufficient volume needed to get a clean colon due to non-palatability. Good results of bowel cleansing have also been reported with sodium phosphate solution or tablets.

The fluid volume needed to drink along with sodium phosphate is generally no problem but this regimen causes electrolyte disturbances and renal insufficiency that usually are subclinical and of no significance. Several combinations of PEG solution and laxatives have been tested before. Low-volume PEG plus Bisacodyl preparation was better tolerated but it was not as effective as standard large-volume PEG and associated with abdominal cramping.

PEG solution 2L and Bisacodyl is used for large bowel cleansing in many centers in the United States and is the standard regimen used in our colonoscopy unit. In this study the investigators compare this standard regimen taken day before colonoscopy with Bolus lukewarm saline solution taken orally with yoga exercise on the day of colonoscopy.

The result of large bowel cleansing is evaluated during the colonoscopy according to a validated scoring method. Time to the first bowel movement and total preparation time are compared. Solution palatability, patient acceptability, abdominal symptoms, discomfort and subjective grading of how hard/easy it was to complete the cleansing program are evaluated with questionnaires.