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Colonoscopy is commonly accepted as the procedure of choice for the detection and treatment of colonic lesions. The current study was undertaken to compare effectiveness and tolerance of different bowel preparations. Three hundred patients were randomized into three groups, to be administered either a senna compound, a polyethylen glycol lavage, or an oral sodium phosphate (NaP) solution. Tolerance of the preparation was considered. After each colonoscopy, the endoscopist blindly scored cleansing for each bowel segment and defined the quality of the examination as “optimal,” “acceptable,” or to be repeated. Significantly more patients in Group C (68%) achieved a “good” cleansing compared with Group B (50%;P < 0.0001) and with Group A (38%;P < 0.005). Sixty-three percent of constipated patients obtained a “good” preparation in Group C, which was significantly higher than in Group A (28%;P < 0.05) and than in Group B (42%;P < 0.02). Feasibility of the examination was considered “optimal” in 80% of procedures in Group C, which was higher than in Group A (59%;P < 0.005) and in Group B (62%;P < 0.005). The tolerance of preparation was “good” in 93% of the examinations for Group C. This prospective randomized trial showed good effectiveness of NaP solutions, with an optimal tolerance. Results of use of the NaP solution showed a clear advantage for constipated patients, with similar results for nonconstipated patients. The author believes that the NaP solution should be the standard preparation for elective colonoscopy.