SHM Converge Scientific Abstract ePoster Gallery-A Thickened Solution: Successful Colonoscopy Preparation in a Patient With Oropharyngeal Dysphagia Without a Nasogastric Tube

A Thickened Solution: Successful Colonoscopy Preparation in a Patient With Oropharyngeal Dysphagia Without a Nasogastric Tube

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This case report describes a practical alternative for colonoscopy preparation in older patients with oropharyngeal dysphagia who cannot safely swallow standard large-volume liquid polyethylene glycol (PEG) bowel prep and may not tolerate nasogastric tube (NGT) placement. NGT administration is often used in such patients, but it can be uncomfortable, difficult in patients with dementia, and may increase aspiration risk.<br /><br />The report explains why the type of thickener matters. Xanthan gum-based nectar-thick liquids keep a stable gel-like consistency, so adding PEG powder does not significantly change the liquid’s thickness. In contrast, starch-based thickeners lose viscosity when PEG is added because the PEG draws water away from the starch structure, making the mixture thinner and potentially increasing aspiration risk.<br /><br />The case supports using powdered PEG (such as Miralax) mixed into xanthan gum-based nectar-thick liquids as a feasible and safe alternative to standard oral liquid bowel prep for patients with dysphagia. However, the authors note limitations, including the need for a longer preparation period, the requirement for clear-liquid or low-residue diet phases, and the absence of a commercially prepared product. They also emphasize that more research is needed to determine optimal dosing and confirm effectiveness.

Asset Subtitle

Sarah A. Tupchong

Meta Tag

Author List Sarah A. Tupchong, Stephanie Maung

Category Clinical Vignettes

Concept Colonoscopy Bowel Preparation

Concept Swallowing Impairment

Concept Polyethylene Glycol

Concept Thickened Liquids

Concept Aspiration Risk

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center, Bronx, NY

Presenting Author Sarah A. Tupchong

Track Adult

Keywords

colonoscopy preparation

oropharyngeal dysphagia

polyethylene glycol

xanthan gum thickener

starch-based thickener

aspiration risk

nasogastric tube

older patients

bowel prep alternative

Miralax

Colonoscopy Bowel Preparation

Swallowing Impairment

Polyethylene Glycol

Thickened Liquids

Aspiration Risk