Colonoscopic examinations are performed routinely in hospitalized patients for a variety of indications. However, numerous limitations exist in hospitalized patients preventing an endoscopist from performing high quality examinations; possibly necessitating repeated procedures leading to increased cost and re-exposure to their inherent risks. One such prominent challenge lays in the adequacy of bowel cleansing. Inpatient status has been shown to be a predictor of poor bowel preparation as these patients are older, less mobile and have more co morbidities than the outpatient population. Currently, no standardized (or optimized) bowel preparation type or regimen for administration exists for the hospital inpatient population undergoing colonoscopy. Studies in the outpatient population have demonstrated that timing and choice of cathartic medication effects the cleanliness of the bowel preparation but there is no such clinical evidence for in-patients who receive whatever cathartic agent is on hospital formulary. The purpose of the study is compare efficacy, patient satisfaction, and adverse effects associated with low volume cathartic (Pico-Salax) to the current standard volume 4 liter (PEG-Lyte) and the effect of alternate timing of dosages.

Inclusion Criteria:

• Inpatient colonoscopy
• Age greater than 18 years old
• Able to give consent

Exclusion Criteria:

• No consent obtained
• Pregnancy or lactating
• Renal impairment
• Severe CHF (NYHA class 3/4)
• Recent myocardial infarction (preceding 6 months)
• Ileus
• Ascites
• Severe Colitis
• Toxic Megacolon
• Gastrointestinal Obstruction
• PEG tube
• Previous large bowel resection
• Allergy to study drug