Preparación Intestinal con Polietilenglicol (PEG)

Indicaciones y Formulaciones

El PEG está indicado como agente de preparación intestinal para colonoscopia, siendo una opción segura y eficaz debido a sus propiedades isotónicas que minimizan los desequilibrios electrolíticos, especialmente en pacientes con comorbilidades significativas, según la sociedad de Gastroenterología 1, 2
Se recomienda seleccionar el régimen de preparación intestinal considerando el historial médico del paciente, sus medicamentos y, cuando esté disponible, la adecuación de la preparación intestinal reportada en colonoscopias previas, como sugiere la sociedad de Gastroenterología 1, 2
PEG-ELS (solución de lavado electrolítico con polietilenglicol) está disponible en formulaciones de alto volumen (4 L) y bajo volumen (<2 L), con la sociedad de Gastroenterología recomendando su uso 1, 3
Marcas comerciales de PEG de 4L aprobadas por la FDA incluyen Colyte, Gavilyte, Golytely y Nulytely (libre de sulfato), según la sociedad de Gastroenterología 2, 4

La dosis dividida de 4L de PEG proporciona una limpieza intestinal de alta calidad para colonoscopia, especialmente en esquema de dosis dividida, como recomienda la sociedad de Gastroenterología 1, 2
PEG es eficaz para el tratamiento del síndrome de intestino irritable con estreñimiento (SII-E), según la sociedad de Gastroenterología 5
La administración en dosis dividida ha demostrado mejor calidad y aceptación de la preparación en muchos estudios, como sugiere la sociedad de Gastroenterología 6

El PEG es un agente iso-osmolar e isotónico, lo que lo hace relativamente seguro para pacientes con comorbilidades significativas, según la sociedad de Gastroenterología 1, 3
Se recomienda evitar regímenes hiperosmóticos en individuos con riesgo de sobrecarga de volumen o alteraciones electrolíticas, como advierte la sociedad de Gastroenterología 1, 3
La calidad de la preparación intestinal es marginalmente mejor con PEG de alto volumen, pero la tolerancia es significativamente mayor con PEG de bajo volumen, según la sociedad de Gastroenterología 1, 3

For adults with fecal impaction in the ascending colon, a high dose of Polyethylene Glycol (PEG) of 4 liters divided over 2 days (2 liters per day) is recommended, according to the American Gastroenterological Association 7, 8
The administration should be done preferably in divided doses to improve tolerability and efficacy of the treatment, as suggested by the American Gastroenterological Association 9, 10

PEG is the agent of choice for fecal impaction because it is isotonic and iso-osmolar, minimizing electrolyte imbalances, especially important in patients with comorbidities, as recommended by the American Gastroenterological Association 8
The use of hyperosmotic preparations should be avoided in patients at risk of volume overload or electrolyte disturbances, according to the American Gastroenterological Association 8, 10

High doses of PEG are more effective than low doses for severe impactions, particularly in the ascending colon where a larger volume is required to reach and soften the feces, as reported by the American Gastroenterological Association 7, 8

The tolerability is significantly higher with low-volume regimens, but the efficacy for fecal impaction is marginally better with high-volume preparations, according to the American Gastroenterological Association 8, 10

For patients with end-stage renal disease (ESRD), the American Gastroenterological Association recommends polyethylene glycol (PEG) without additives as the safest bowel preparation for colonoscopy, administered as a 2L split-dose regimen with careful monitoring of electrolytes and hydration status 11, 12
Medical history is a critical factor in selecting an appropriate bowel preparation regimen, with ESRD requiring special consideration due to risks of fluid and electrolyte disturbances 13, 14
Hyperosmotic preparations (sodium phosphate, magnesium-containing preparations) must be avoided in ESRD patients due to high risk of electrolyte abnormalities and volume overload 14
PEG-based preparations are preferred for ESRD patients because they are iso-osmolar and isotonic, minimizing electrolyte imbalances in this vulnerable population 15

The American Gastroenterological Association recommends using standard PEG without additives (no ascorbate, sulfate, or other electrolytes) as these additives may accumulate in ESRD patients 12
Administering PEG as a 2L split-dose regimen rather than 4L is recommended to improve tolerability while maintaining adequate cleansing efficacy 11, 15

The American Gastroenterological Association advises against using sodium phosphate preparations in ESRD patients due to high risk of acute phosphate nephropathy and electrolyte disturbances 12
Avoid assuming that low-volume preparations are automatically safer; many contain additives that may be problematic in ESRD 15
Do not use PEG with ascorbate in ESRD patients, as ascorbate can accumulate and potentially cause metabolic disturbances 15
Beware of inadequate hydration during preparation, which can worsen electrolyte abnormalities; provide specific hydration instructions appropriate for the patient's fluid restriction status 14