What is the best strategy for successful bowel preparation under special conditions?

Table 1 Bowel preparation under special conditions

Special condition	Considerations for appropriate bowel preparation
Elderly	Avoid NaP to reduce risk of electrolyte imbalance and phosphate accumulation
Childhood	1.25 mg/kg PEG for 4 d with liquid diet on the fourth day
Pregnancy	PEG may be preferable to NaP
Breastfeeding	Interrupt breastfeeding during and after bowel preparation
Severe/chronic constipation	Extend the liquid diet requirement
	Alternate the bowel preparation agent (PEG or NaP)
	Provide adjunctive laxative agents (magnesium citrate, bisacodyl, or senna)
	Apply a combined bowel preparation agent (both PEG and NaP) or double the dosage of PEG solution
Stroke, dementia	If patients have difficulty swallowing, provide the bowel preparation agent via endoscopic irrigation pump or nasogastric tube
IBD	NaP and sodium picosulfate plus magnesium citrate should be avoided because of mucosal damage and irritation
Diabetes	Appropriate dose and proper tempo of fluid intake is important because of delayed colonic transit time
	NaP should be avoided due to possible risk of hyperphosphatemia, metabolic acidosis, and renal failure
Hypertension	NaP should be cautiously applied in patients taking a drug that affects renal function (diuretics, ARB, ACEi)
Chronic kidney disease	NaP preparation is not recommended because of increased risk of renal dysfunction
Congestive heart failure	PEG solution should be cautiously applied because of an association with increased intravascular volume
	NaP preparation is not recommended because of electrolyte imbalance and volume loss
Lower GI bleeding	PEG solution may be more effective than enema
	If a rectal bleeding focus is suspected or severe bleeding is present, enema can be useful

NaP: Sodium phosphate; PEG: Polyethylene glycol; ARB: Angiotensin receptor blockers; ACEi: Angiotensin converting enzyme inhibitors; IBD: Inflammatory bowel disease; GI: Gastrointestinal.