To the Editor:

The information provided in the recent article by Debra McCormick, RN, and colleagues, entitled Colon Cancer (McCormick, Kibbe & Morgan, 2002) is of great interest since colon cancer is preventable through colonoscopy screening. Unfortunately, the bowel preparation for colonoscopy is what patients remember as "the worst part" of the entire process. Healthcare professionals should strive to make the bowel prep process as comfortable as possible. To that end, McCormick and colleagues made several statements that need to be clarified.

First, the statement, "Fleet phospho-soda prep requires 2 days of clear liquids and two 1.5 oz. drinks of the prep the afternoon prior to the exam (Fleet phospho-soda product information)" is dated. The current diet regimen for Fleet^(R) Phospho-soda^(R) allows for a light, low-residue breakfast the morning before the procedure followed by clear liquids until after the procedure (http://www.phospho-soda.com). More importantly, Fleet recommends separating each 45 mL dose by 10-12 hours. The standard dosing regimen calls for Dose #1 to be given at 7 PM the night before the procedure and Dose #2 at either 6AM the next morning or at least 3 hours prior to the procedure (http://www.phospho-soda.com).

Second, the authors wrote ""With this prep, the colonic mucosa tends to be drier during the exam and patients may therefore experience more discomfort." C.B. Fleet Company, Inc. is not aware of any published scientific data that indicates the Fleet Phospho-soda prep causes discomfort due to colonic mucosal dryness. While there is a published paper (Macari, et al., 2000) that indicates the colon is drier after using Fleet Phospho-soda than using PEG solutions when used for virtual colonoscopy, the authors make no mention of patient discomfort.

Third, the statement "Visicol is Fleet phospho-soda in tablet form" needs clarification. Visicol is a large sodium phosphate tablet, but the total dose of sodium phosphates consumed under their FDA approved 2 x 20 tablet regimen (http://www.visicol.com) is higher than that with the standard 2 x 45 mL dose of Fleet Phospho-soda.

Two 45 mL doses of Fleet Phospho-soda taken 10-12 hours apart provide superior bowel cleansing effectiveness (Hsu & Imperiale, 1998); result in a greater degree of patient compliance (Golub, et al., 1995); and provide a safe, effective, and inexpensive method of bowel preparation for endoscopic or radiologic examinations or surgery.

Sherrie Scott, RN

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