EP145 - Linaclotide As a Single-Agent Bowel Preparation Regimen Before Colonoscopy.

Saturday, May 10, 2025

3:47 PM – 3:52 PM PT

Location: Monitor 6, Sails Pavilion, Upper Level

ePoster Presenter(s)

James E. Montgomery, MD

General Surgery Resident
University of Florida College of Medicine
Gainesville, FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Pavel Mazirka, MD

Surgery Resident
University of Florida - Gainesville, FL
Gainesville, FL, United States

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This individual has no financial relationships with ineligible companies.
Christine Rodhouse, MD (she/her/hers)

General Surgery Resident
University of Florida
Gainesville, FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Jeremy A. Balch, MD (he/him/his)

House Officer
University of Florida
University of Florida
Gainesville, FL, United States

All of the relevant financial relationships listed below have been mitigated.
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Thomas E. Read, MD

Professor of Surgery
University of Florida College of Medicine
University of Florida College of Medicine
Gainesville, Florida, United States

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This individual has no financial relationships with ineligible companies.
KT

Krista P. Terracina, MD

Assistant Professor
University of Florida
Gainesville, Florida, United States

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LG

Lindsey E. Goldstein, MD

Assistant Professor
University of Florida
Gainesville, Florida, United States

Disclosure information not submitted.

Senior Author(s)

JN

Johan Nordenstam, MD, PhD

Associate Professor
University of Florida
Gainesville, Florida, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

James E. Montgomery, MD: This individual has no financial relationships with ineligible companies.

Pavel Mazirka, MD: This individual has no financial relationships with ineligible companies.

Christine Rodhouse, MD: This individual has no financial relationships with ineligible companies.

Jeremy A. Balch, MD: This individual has no financial relationships with ineligible companies.

Thomas E. Read, MD: This individual has no financial relationships with ineligible companies.

Krista P. Terracina, MD: This individual has no financial relationships with ineligible companies.

Johan Nordenstam, MD, PhD: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Linaclotide is a novel, FDA-approved, intestinal prosecretory agent used for chronic constipation with reported potential for utilization as an adjunct to polyethylene glycol (PEG) oral preparation for colonoscopy and capsule endoscopy. Linaclotide has not, to our knowledge, been reported as a single-agent bowel preparation.

Methods/Interventions: A report of two patients who presented for colonoscopy having taken linaclotide and dietary restrictions as their only bowel preparation regimen.

Results/Outcomes: A 33-year-old woman presented with a 15-month history of recurrent painless anal bleeding and sensation of prolapse during defecation. Her medical history was significant for obesity (BMI 40 kg/m2) and chronic constipation managed with linaclotide 290 mcg capsule taken once daily. The patient was scheduled for colonoscopy and instructed to undergo oral cathartic bowel preparation per our institution’s protocol. However, on the day of the procedure, the patient reported that she was not able to obtain the prescribed regimen and instead took three 290 mcg capsules of linaclotide and fasted the night prior. She described her stools as brown liquid that gradually cleared leading up to the time of the procedure. The decision to attempt the colonoscopy was made with patient’s informed consent. A complete colonoscopy was performed. The quality of the bowel preparation was determined to be adequate with a minor amount of residual staining and small stool fragments [Boston Bowel Preparation Score (BPPS) = 6], see Fig. 1. The patient tolerated the procedure well without complications.

A 34-year-old man with no pertinent medical or surgical history underwent a diagnostic colonoscopy after presenting with a 3-month history of asymptomatic bright red blood with a normal physical exam. On the evening prior to the colonoscopy, the patient took one 290mcg dose of linaclotide, and a second 290mcg dose of linaclotide the following morning. The patient also started a clear liquid diet the day before the procedure but did not take any cathartic agents. This regimen resulted in adequate bowel preparation with a total BBPS of 7, see Fig. 2. The procedure was well tolerated without complications.

Conclusion/Discussion: Our experience demonstrates the potential application of linaclotide as a well-tolerated, single-agent bowel preparation regimen prior to colonoscopy that warrants further study. A randomized, controlled trial is planned to further investigate a single-agent linaclotide versus traditional PEG-based bowel preparation regimen.