Journal of Gastrointestinal & Digestive System
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Novel colonoscopy preparation of organic coconut water with miralax and dulcolax in split doses for decompensated cirrhotics: A randomized double blinded open labelled clinical pilot single centered observational study. COSMIC study
4th International Conference on Gastroenterology
Basu Patrick P1,3, Shah Niraj James2, Aloysius Mark M3 and Brown Jr. Robert S1
Background: Screening colonoscopy is routine for patients been evaluated for OLT. Cirrhotics have small bowel and colonic
dysmotility due to splenic vasodilatation and on-going low flow ischemia with functional constipation and dyselectrolytemia.
During the past 40 years, trials comparing different bowel preparations have used a variety of bowel preparation scales (BPSs)
to measure colon cleanliness for colonoscopy. Most aqueous colonoscopy preparations are poorly tolerated and this ultimately
leads to poor compliance (approximately 34%) affecting diagnosis and morbidity. Green coconut water had been a main source
for rehydration and sterile source of water replacement in the tropics for centuries.
Aim: To evaluate the efficacy, safety and utility of coconut water as a vehicle for colon cleansing with Miralax for decompensated
Methods: Sixty (n=60) patients aged 45-69 (MELD 16-20, with moderate ascites and MHE on Diuretics, Lactulose and Xifaxan)
were recruited- Single center, one gastroenterologist, anesthesiologist, nurse and medical assistant. All were placed on total
liquids of 1200 cc along with a semi solid diet: 2 grams sodium, 120 grams protein, 2300 cal/day, ice cream, 1 liter of natural
coconut water with 8 oz of Miralax from 4:00 pm till 10:00 pm and 4 tablets of Dulcolax 5 mg each (at bed time). Total mean
nocturnal bowel movements were 3-5 in am from 7:00 am till 10:00 am with Miralax 8 oz and 1 liter of coconut water. All
diuretics were stopped 2 days prior to the initiation of the spilt doses of prep. Questionnaire was taken post prep in the morning
and then again taken post procedure.
Conclusions: This study postulates a novel organic coconut water preparation with Miralax compared to traditional preparation
to be safe (lesser dyselectrolytemia), well tolerated with wide satisfactory score and greater retention. It has greater efficacy with
no side events in special population (decompensated cirrhotics awaiting OLT)
HistoScanning? has the potential to become a first line diagnostic test of triage test before biopsy as it is a rather simple, fully
available, minimal invasive test that can be done and repeated in the urologists practice.
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