The Challenges of Traditional Colonoscopy Preparation
For years, preparing for a colonoscopy involved drinking large quantities—often up to four liters—of a high-volume liquid laxative. These polyethylene glycol (PEG)-based solutions, while effective, were known for their unpleasant, salty taste and could be difficult for many patients to complete. Incomplete prep is a significant problem, as it can compromise the accuracy of the procedure and may necessitate a repeat colonoscopy. The unpleasant taste and sheer volume of the liquid contributed to low patient compliance and satisfaction, leading many to delay or avoid screenings altogether.
Recognizing these barriers, pharmaceutical companies and gastroenterologists have worked to develop more tolerable alternatives. The goal is to improve patient experience and adherence, ultimately increasing the success rate of this vital colorectal cancer screening procedure.
The Arrival of New, Low-Volume Options
Over the past decade, a new generation of colonoscopy preps has emerged, focusing on reduced liquid volume and improved palatability. Key players include SUTAB (an oral tablet) and SUFLAVE (a low-volume liquid), both designed to address the shortcomings of older preparations.
SUTAB: The Pill-Based Approach
SUTAB (sodium sulfate, magnesium sulfate, and potassium chloride) was approved by the FDA in 2020 as a tablet-based alternative for colonoscopy prep. It functions as an osmotic laxative, drawing water into the colon to induce bowel movements. Instead of consuming large volumes of a flavored liquid, patients take 24 tablets in a split-dose regimen: 12 tablets the evening before the procedure and 12 the morning of. Each dose of tablets is taken with a prescribed amount of water, which is then followed by additional water consumption.
The main advantages of SUTAB are the elimination of taste issues and a significantly reduced volume of prep solution to consume. Clinical trials showed high rates of successful bowel cleansing with SUTAB, comparable to traditional liquid preparations, and higher patient satisfaction ratings. However, it is not suitable for everyone; it is contraindicated in patients with kidney impairment, congestive heart failure, or other conditions where electrolyte imbalances are a concern.
SUFLAVE: A Palatable Liquid Alternative
SUFLAVE is a low-volume, lemon-lime flavored liquid preparation that received FDA approval in 2023. Developed by the same company as SUTAB, it is a PEG-based solution engineered for improved taste, addressing a major patient complaint about traditional preps. SUFLAVE also uses a split-dose regimen, requiring patients to consume less liquid overall compared to older, high-volume options. This focus on a more palatable flavor profile and lower volume aims to boost patient willingness to complete the preparation fully, thereby improving the quality of the colonoscopy.
Comparison of Modern Colonoscopy Preps
| Feature | SUTAB (Oral Tablets) | SUFLAVE (Low-Volume Liquid) | Traditional PEG (e.g., GoLYTELY) |
|---|---|---|---|
| Formulation | Oral sulfate tablets | Lemon-lime flavored liquid | Large-volume liquid (typically unflavored/salty) |
| Volume | Low volume of tablets; requires significant water intake | Low volume liquid to consume | High volume (up to 4 liters) |
| Taste | Tasteless tablets; taste of water only | Lemon-lime flavored | Unpleasant, salty taste commonly reported |
| Patient Experience | Higher patient satisfaction, less taste aversion | Improved palatability, better tolerance | Often challenging to tolerate due to high volume and taste |
| Compliance | High completion rates in trials, despite pill count | Higher completion rates due to better taste | Lower completion rates due to difficulty finishing |
| Cost | Can be more expensive, depending on insurance coverage | Cost may vary; often more expensive than generics | Generally less expensive, especially generics |
Recent Guideline Updates and What They Mean for Patients
In March 2025, the U.S. Multi-Society Task Force on Colorectal Cancer (MSTFCRC) released updated guidelines for colonoscopy bowel preparation. The recommendations emphasize split-dose regimens for all patients, regardless of prep volume, and set a new benchmark for prep adequacy at over 90%. These guidelines highlight the importance of low-volume preparations and adjuncts like simethicone to enhance the quality of the procedure. For individuals with specific risks, such as a history of inadequate prep or certain comorbidities, the guidelines suggest a tailored approach, which may involve modified diets or specific agents. These recommendations underscore the clinical community's push towards more effective, patient-centric preparation strategies. You can read the full guidance published in Gastroenterology here.
Conclusion
The introduction of new prep medications for colonoscopy, such as SUTAB and SUFLAVE, represents a significant advancement in patient care. By addressing the issues of taste and volume associated with traditional high-volume liquids, these alternatives improve patient tolerance and increase the likelihood of a successful, effective procedure. The move toward low-volume and tablet options is further supported by updated clinical guidelines that prioritize patient compliance and high-quality bowel cleansing. Choosing the right preparation involves a discussion with your doctor, considering your medical history and personal preferences to ensure the best possible experience and outcome.
