Patients' description of rectal effluent and quality of bowel preparation at colonoscopy

Fatima, Hala; Johnson, Cynthia S.; Rex, Douglas K.

doi:10.1016/j.gie.2009.11.053

Cited by 59 publications

(54 citation statements)

References 14 publications

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“…Recognizing individuals likely to have a poor preparation at the time of arrival to the endoscopy suite might allow for salvage eff orts before sedation. One study found that those reporting brown liquid or solid effl uent had a 54% chance of having a fair or poor preparation ( 228 ). In such cases, further preparation with large-volume enemas or additional oral preparation could be considered.…”

Section: Salvage Options For Inadequate Preparationmentioning

confidence: 99%

“…We identifi ed 16 reports (15 observational studies ( 2,4,61,228,(237)(238)(239)(240)(241)(242)(243)(244)(245)(246)(247) and 1 trial ( 248 ) ) that identifi ed patientrelated variables associated with a poor-quality bowel cleansing. Observational studies that used only univariate analysis (n=5) were not considered further ( 237,238,242,247,248 ).…”

Section: Risk Factors For Inadequate Preparationmentioning

confidence: 99%

“…For example, in a large (n=5832) multicenter study performed in Europe and Canada, those with an American Society of Anesthesiologists status of class III through class V were signifi cantly less likely to accomplish a high-quality preparation relative to American Society of Anesthesiologists class I patients (OR, 0.51; 95% CI, 0.32-0.73) ( 2 ) Nguyen and Wieland ( 245 ) retrospectively analyzed reports of 300 screening colonoscopy patients and found that patients with 8 or more prescriptions were signifi cantly more likely to have a poor colonoscopy preparation (OR, 6.52; 95% CI, 5.12-8.56). Neurologic conditions associated with poor mobility such as stroke and Parkinson's disease ( 61,228,239,244 ) also frequently were associated with inadequate preparation. A history of prior gastrointestinal surgical resection ( 61,240,245 ) also was found to be associated with poorer preparation quality.…”

Section: Appendix Bmentioning

confidence: 99%

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Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Johnson

Barkun

Cohen

et al. 2014

American Journal of Gastroenterology

136

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The American Journal of GASTROENTEROLOGY PRACTICE GUIDELINESColorectal cancer (CRC) is the second leading cause of cancerrelated deaths in the United States ( 1 ). Colonoscopy can prevent CRC by the detection and removal of precancerous lesions. In addition to CRC screening and surveillance, colonoscopy is used widely for the diagnostic evaluation of symptoms and other positive CRC screening tests. Regardless of indication, the success of colonoscopy is linked closely to the adequacy of preprocedure bowel cleansing.Unfortunately, up to 20-25% of all colonoscopies are reported to have an inadequate bowel preparation ( 2,3 ). Th e reasons for this range from patient-related variables such as compliance with preparation instructions and a variety of medical conditions that make bowel cleansing more diffi cult to unit-specifi c factors (eg, extended wait times aft er scheduling of colonoscopy) ( 4 ). Adverse consequences of ineff ective bowel preparation include lower adenoma detection rates, longer procedural time, lower cecal intubation rates, increased electrocautery risk, and shorter intervals between examinations ( 3,5-7 ).Bowel preparation formulations intended for precolonoscopy cleansing are assessed based on their effi cacy, safety, and tolerability. Lack of specifi c organ toxicity is considered to be a prerequisite for bowel preparations. Between cleansing effi cacy and tolerability, however, the consequences of inadequate cleansing suggest that effi cacy should be a higher priority than tolerability. Consequently, the choice of a bowel cleansing regimen should be based on cleansing effi cacy fi rst and patient tolerability second. However, effi cacy and tolerability are closely interrelated. For example, a cleansing agent that is poorly tolerated and thus not fully ingested may not achieve an adequate cleansing.Th e goals of this consensus document are to provide expert, evidence-based recommendations for clinicians to optimize colonoscopy preparation quality and patient safety. Recommendations are provided using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) scoring system, which weighs the strength of the recommendation and the quality of the evidence ( 8 ). METHODS Search StrategyComputerized medical literature searches were conducted from January 1980 (fi rst year of approval of polyethylene glycol-electrolyte lavage solution [PEG-ELS]-based preparation by the Food and Drug Administration [FDA]) up to August 2013 using MEDLINE, PubMed EMBASE, Scopus, CENTRAL, and ISI Web of knowledge. We used a highly sensitive search strategy to identify reports of randomized controlled trials ( 9 ) with a combination of medical subject headings adapted to each database and text words related to colonoscopy and gastrointestinal agents, bowel preparation, generic name, and brand name. Th e complete search terms are available in Appendix A. Recursive searches and cross-referencing also were performed using a "similar articles" function; hand searches of articles were identifi ed aft er an i...

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Section: Salvage Options For Inadequate Preparationmentioning

confidence: 99%

Section: Risk Factors For Inadequate Preparationmentioning

confidence: 99%

Section: Appendix Bmentioning

confidence: 99%

See 1 more Smart Citation

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Johnson

Barkun

Cohen

et al. 2014

American Journal of Gastroenterology

136

View full text Add to dashboard Cite

show abstract

“…Last, stool characteristics of the participant’s last rectal effluent and the onset to first bowel movement positively predicted suboptimal bowel preparation. Fatima et al 11 found that patients with a brown liquid or solid stool had a 54% chance of having fair or poor preparation. We even found that patients with watery stool with flecks of particulates had an almost threefold risk of suboptimal bowel preparation.…”

Section: Discussionmentioning

confidence: 99%

“…6–11 Risk factors for suboptimal colonoscopy preparation include diabetes, hypertension, cirrhosis, constipation, age, male sex, and the use of tricyclic antidepressants. 6,7,9 However, these data were acquired before the use of split-dose bowel preparation.…”

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confidence: 99%

Patient compliance and suboptimal bowel preparation with split-dose bowel regimen in average-risk screening colonoscopy

Menees

Kim²,

Wren

et al. 2014

Gastrointestinal Endoscopy

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Background Although split-dose bowel regimen is recommended in colon cancer screening and surveillance guidelines, implementation in clinical practice has seemingly lagged because of concerns of patient compliance. Objectives To assess patient compliance with the split-dose bowel regimen and assess patient- and preparation process–related factors associated with compliance and bowel preparation adequacy. Design Prospective survey cohort. Setting Tertiary care setting. Patients Average-risk patients undergoing colonoscopy for colorectal cancer screening between August 2011 and January 2013. Main Outcome Measurements Split-dose bowel regimen patient-reported compliance and bowel preparation adequacy with the Boston Bowel Preparation Scale score. Results Surveys and Boston Bowel Preparation Scale score data were completed in 462 participants; 15.4% were noncompliant with the split-dose bowel regimen, and suboptimal bowel preparation (score < 5) was reported in 16% of all procedures. White (P = .009) and married (P = .01) subjects were least likely to be noncompliant, whereas Hispanic subjects and those who reported incomes of US$75,000 or less were most likely to be noncompliant (P = .004). Participants who were noncompliant with split-dosing were less likely to follow the other laxative instructions and more likely to have their colonoscopy appointment before 10:30 am. Compliance differed by bowel preparation type (P = .003, χ2 test), with those who used MiraLAX showing the highest compliance, followed by polyethylene glycol electrolyte solution and other bowel preparations. Noncompliance with split-dose bowel preparation (odds ratio 6.7; 95% confidence interval, 3.2–14.2) was the strongest predictor of suboptimal bowel preparation. Limitations Patient self-report, performed at tertiary care center. Conclusions Overall, 1 in 7 patients do not comply with a split-dose bowel regimen. Ensuring compliance with the split-dose bowel regimen will reduce the risk of a suboptimal bowel preparation. (Gastrointest Endosc 2014;79:811-20.)

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Augmentation with pre‐emptive macrogol‐based osmotic laxative does not significantly improve standard bowel preparation in unselected patients: A randomized trial

et al. 2019

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Background and Aim The addition of a laxative prior to a standard bowel preparation (BP) has shown variable results in efficacy, safety, and tolerability of the BP. This study compared the efficacy and tolerability of a macrogol‐augmented BP (M‐BP) with standard BP for routine colonoscopy in unselected patients. Methods Adults undergoing outpatient colonoscopy were randomized to either M‐BP (one sachet of macrogol‐based osmotic laxative (MBOL) twice daily for eight doses prior to standard preparation) or BP (split‐dose of polyethylene glycol and sodium picosulfate). Bowel cleansing was assessed using the Ottawa BP scale. Risk factors for poor BP, patient satisfaction, and tolerance were recorded. Results This randomized trial was stopped due to futility after 14 months; at that point, 92 subjects were randomized to the study arm and 102 to the control arm. M‐BP had a success rate of 71.7% (95% CI: 58.5–82.7%), while the BP had a success rate of 67.7% (95% CI: 54.9–78.8%), with a Pearson χ2 test P‐value of 0.639, which exceeded the cut‐off for futility (0.313). In subgroup analyses, there were statistically significant decreases in the rates of successful BP in patients taking regular opioids and regular laxatives. Both preparations were well tolerated, with no difference between groups (BP – 5.3% and M‐BP – 6.6% P = 0.66). Conclusion The addition of MBOL prior to a standard BP in unselected subjects does not significantly improve bowel cleanliness at routine colonoscopy. The role of this laxative in patients at high risk of poor preparation warrants further investigation.

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Patients' description of rectal effluent and quality of bowel preparation at colonoscopy

Cited by 59 publications

References 14 publications

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Patient compliance and suboptimal bowel preparation with split-dose bowel regimen in average-risk screening colonoscopy

Augmentation with pre‐emptive macrogol‐based osmotic laxative does not significantly improve standard bowel preparation in unselected patients: A randomized trial

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