Novel Colonoscopy Preparation of Organic Coconut Water With Miralax and Dulcolax in Split Doses for Decompensated Cirrhotics. A Randomized Double Blinded Open Labelled Clinical Pilot Single Centered Observational Study. COSMIC Study

Introduction: Screening colonoscopy is routine for patients been evaluated for OLT. Most aqueous colonoscopy preparations are poorly tolerated, cause gross dyselectrolytemia and even renal dysfunction. This ultimately leads to poor compliance affecting diagnosis. This pilot study evaluates the efficacy, safety and utility of coconut water as a vehicle for colon cleansing with Miralax® for decompensated cirrhotics being evaluated for OLT undergoing screening colonoscopy.Table 1: ResultsMethods: Sixty (n=60) patients aged 45-69 (MELD 16-20, with moderate ascites and MHE on diuretics, lactulose and Xifaxan’) were recruited. Single center, one gastroenterologist, anesthesiologist, nurse and medical assistant. All were on Lasix (mean dose of 60 mg daily), Aldactone® 100 mg, Lactulose 30 mL and Xifaxan® 550 mg BID. All were placed on total liquids of 1200 cc along with a semi solid diet: 2 grams sodium, 120 grams protein, 2300 cal/day, ice cream, 1 liter of natural coconut water with 8 oz of Miralax® from 4:00 pm till 10:00 pm and 4 tablets of Dulcolax® 5 mg each (at bed time). Total mean nocturnal bowel movements were 3-5 in am from 7:00 am till 10:00 am with Miralax® 8 oz and 1 liter of coconut water. All diuretics were stopped 2 days prior to the initiation of the spilt doses of prep. Questionnaire was taken post prep in the morning and then again post procedure Results: Kindly refer to table. Conclusion: This study postulates a novel organic coconut water preparation with Miralax® compared to traditional preparation to be safe (lesser dyselectrolytemia), well tolerated with wide satisfactory score and greater retention. It has greater efficacy with no side events in special population (decompensated cirrhotics awaiting OLT).