Gastroenterologists' patient instructions for oral sodium phosphate solution for colonoscopy preparation: a survey among gastroenterologists in the state of Indiana

The impact of bowel cleansing on follow-up recommendations in average-risk patients with a normal colonoscopy

OBJECTIVES

Repeat colonoscopy in 10 years after a normal screening colonoscopy is recommended in an average-risk patient, and it has been proposed by American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), and American Society for Gastrointestinal Endoscopy (ASGE) as a quality measure. However, there are little quantitative data about adherence to this recommendation or factors that may improve adherence. Our study quantifies adherence to this recommendation and the impact of suboptimal bowel preparation on adherence.

METHODS

In this retrospective database study, endoscopy reports of average-risk individuals ≥50 years old with a normal screening colonoscopy were reviewed. Quality of colon cleansing was recorded using the Aronchick scale as excellent, good, fair, or poor. Main outcome measurements were quality of bowel preparation and recommendation for timing of repeat colonoscopy. Recommendations were considered consistent with guidelines if 10-year follow-up was documented after excellent, good, or fair prep or if ≤1-year follow-up was recommended after poor prep.

RESULTS

Among 1,387 eligible patients, recommendations for follow-up colonoscopy inconsistent with guidelines were seen in 332 (23.9%) subjects. By bowel preparation quality, 15.3% of excellent/good, 75% of fair, and 31.6% of poor bowel preparations were assigned recommendations inconsistent with guidelines (P<0.001). Patients with fair (odds ratio=18.0; 95% confidence interval 12.0-28.0) were more likely to have recommendations inconsistent with guidelines compared with patients with excellent/good preps.

CONCLUSIONS

Recommendations inconsistent with guidelines for 10-year intervals after a normal colonoscopy occurred in >20% of patients. Minimizing "fair" bowel preparations may be a helpful intervention to improve adherence to these recommendations.

Split-dose bowel preparation for colonoscopy and residual gastric fluid volume: an observational study

BACKGROUND

Split-dose bowel preparations for colonoscopy are more effective and better tolerated than preparations given entirely the day or evening before the procedure; however, some resistance to split-dose preparation stems from concerns about an increased risk of aspiration with same-day preparation.

OBJECTIVE

We sought to evaluate residual gastric volumes in patients after split-dose bowel preparations.

DESIGN

Prospective measurement of residual gastric volumes in patients undergoing same-day EGD and colonoscopy after split-dose bowel preparations, patients undergoing EGD alone, or patients undergoing EGD and colonoscopy after bowel preparation given entirely the evening before the procedure.

SETTING

Tertiary care hospital-based endoscopy unit.

PATIENTS

This study involved 712 patients, including 254 in the split-dose bowel preparation group, 411 in the EGD-only group, and 47 in the evening-before-procedure bowel preparation group.

INTERVENTION

Measurement of residual gastric volume before endoscopic procedures.

MAIN OUTCOME MEASUREMENTS

Residual gastric volume.

RESULTS

The mean residual gastric volume in patients receiving split-dose bowel preparation (19.7 mL) was higher than in patients undergoing EGD alone (14.6 mL) but not different from that in patients receiving bowel preparation the evening before the procedure (20.2 mL). Within the split-dose preparation group, there was no association between the interval from last actual fluid ingestion and procedure start time and the residual gastric volume. The range of residual gastric volumes between study arms was similar.

LIMITATIONS

Nonrandomized study. The number of inpatients undergoing split-dose bowel preparation was small.

CONCLUSION

These data support the safety of split-dose bowel preparation for outpatients undergoing colonoscopy.

Willingness to undergo split-dose bowel preparation for colonoscopy and compliance with split-dose instructions

BACKGROUND

Split-dose bowel preparations for colonoscopy have superior effectiveness compared with giving all the preparation the evening before colonoscopy. Some physicians believe that split-dose preparations would be unpopular with patients scheduled for early morning colonoscopies.

AIMS

To determine the willingness of potential patients to undergo split-dose bowel preparation for colonoscopy and the actual adherence of colonoscopy patients to split-dose instructions.

METHODS

We performed a survey of esophagogastroduodenoscopy patients and drivers of colonoscopy patients asking whether they would accept split-dose preparations for early morning colonoscopy appointments. We also asked colonoscopy patients scheduled in the early morning if they had complied with the written preparation instructions.

RESULTS

Of the 300 individuals surveyed, the majority (85%) stated they would be willing to get up during the night to take the second dose of preparation. Of 107 colonoscopy patients with early morning appointments, 78% actually got up during the night to take the second dose of preparation.

CONCLUSIONS

Acceptance of and compliance with split-dose bowel preparations is high and should not be a deterrent to prescribing split-dose preparations for colonoscopy.