Predictors of inadequate bowel preparation for colonoscopy

Ness, Reid M.; Manam, Raj; Hoen, Helena; Chalasani, Naga

doi:10.1111/j.1572-0241.2001.03874.x

Cited by 424 publications

(272 citation statements)

References 15 publications

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“…Advanced age, comorbid illness and other factors contribute to a decreased ability of hospitalized patients to comply with oral preparation for colonoscopy [2,3] . In particular, a substantial number of patients are unable to consume the most commonly-prescribed regimen, large-volume PEG electrolyte solution, for colonoscopy preparation.…”

Section: Discussionmentioning

confidence: 99%

“…Particularly among hospitalized patients, inadequate bowel preparation for colonoscopy may arise due to patient intolerance to the prescribed laxative regimen. In contrast to the ambulatory population, hospitalized patients are more often elderly and more likely to have co-existing conditions that impair their ability to ingest a large-volume laxative regimen [2,3] . Suboptimal bowel preparation may in turn lead to repeat endoscopic procedures, invasive interventions such as nasogastric tube insertion for administration of purgative agents, and additional days of hospitalization [4] hospital costs.…”

Section: Introductionmentioning

confidence: 99%

“…For example, advanced age, hospital setting and comorbid illnesses have been demonstrated as factors that reduce the quality of bowel preparation [2,3] . Suggestions to improve patient tolerance of bowel preparation include reducing the volume of purgative ingested, splitting the amount of purgative into two separate doses, and administering adjuvant agents to improve gastric emptying and reduce nausea and vomiting associated with ingestion of purgatives [5] .…”

Section: Introductionmentioning

confidence: 99%

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Esophagogastroduodenoscopy-assisted bowel preparation for colonoscopy

Barclay

2013

WJGE

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AIM:To compare the quality and tolerance of esophag ogastroduodenoscopy (EGD)-assisted and conventional split-dose polyethylene glycol electrolyte solution for inpatient colonoscopy. METHODS:The study was a randomized controlled trial in hospitalized patients. Hospitalized patients undergoing colonoscopy the day following EGD for evaluation of gastrointestinal (GI) bleeding or other symptoms. Patients randomized to either EGD-assisted bowel prep [2 L polyethylene glycol (PEG) administered endoscopically into distal duodenum at time of EGD, plus 1 L PEG orally the following day] or conventional-PEG (2 L PEG orally the evening prior and 1 L PEG orally the following day). The main outcome measurements are bowel preparation quality and patient tolerance of bowel prep. RESULTS:Forty-two patients randomized to EGD-assisted bowel prep and 40 patients to conventional-PEG. Overall mean ± SD preparation quality was superior for EGD-PEG (4.1 ± 2.8) vs conventional-PEG (6.5 ± 3.1; P = 0.0005). Seventy-four percent of patients rated EGD-PEG as easy or slightly difficult to tolerate compared to 46% for standard-PEG (P = 0.0133). Mean EGD-procedural time was greater for EGD-assisted subject (24 ± 10 min) compared to conventional-PEG prep subjects (15 ± 7 min; P < 0.0001). Conscious sedation requirements did not differ between groups. There were no significant prep-related adverse events in either group. CONCLUSION:In selected hospitalized patients, compared to a conventional split-dose regimen, use of EGD to administer the majority of PEG solution improves patient tolerance and quality of bowel preparation for colonoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Esophagogastroduodenoscopy-assisted bowel preparation for colonoscopy

Barclay

2013

WJGE

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“…Despite more than 14 million colonoscopies being performed each year, the historic rates for adequate cleansing are unacceptably low and range from 70-82% (10)(11)(12)(13). Recent studies have shown that ingesting at least part of the purgative on the day of colonoscopy and coordinating the final dose of purgative with the start time of colonoscopy is more likely to result in adequate colon cleansing (2)(3)(4)(5).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Morning-Only Compared With Split-Dose Polyethylene Glycol Electrolyte Solution for Afternoon Colonoscopy: A Randomized Controlled Single-Blind Study

Matro

Shnitser

Spodik

et al. 2010

American Journal of Gastroenterology

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“…Additionally, the study did not include inpatients who have been shown to have significantly worse bowel preps than outpatients presenting for colonoscopy. 21,22 These data combined with the current study in non-selected VHA patients clearly indicate that split dosing of PEG bowel preparations is effective and feasible.…”

Section: Discussionmentioning

confidence: 52%

Effectiveness of a simplified “patient friendly” split dose polyethylene glycol colonoscopy prep in Veterans Health Administration patients

Cohen

Tang²,

Groessl³

et al. 2012

jig

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Background and Objectives:Adequate colon cleansing is an important factor in performing quality colonoscopy. Split dose Polyethylene Glycol (PEG) solutions have been shown to improve colon cleansing, but the effectiveness in a large clinical practice of elderly co-morbid patients has not been demonstrated. The aim of this study was to assess the efficacy of a simplified split PEG bowel prep in Veterans Health Administration (VHA) patients. Methods: Prospective pre-post study design of VHA patients undergoing routine colonoscopy. Bowel prep quality was assessed using a standardized semi-quantitative 5-point scale. "Standard" 4L PEG prep was consumed once the evening before the procedure. "Split" prep was consumed half in the early evening and half in the late evening or early morning depending on procedure time. Results: Right colon preps were Excellent/Good in 81.4% of split preps (n=199) vs. 63% of standard preps (n=447, p<0.001). Left colon preps were Excellent/Good in 85.9% of split preps vs. 71.6% of standard preps (p<0.001). Diabetics (n=133) had significantly more right colon preps rated fair or worse compared to non-diabetics irrespective of prep (39.9% vs. 29.0%, p=0.02). Split prep in diabetics resulted in fewer right colon preps rated fair or worse compared to diabetics using standard prep (28.3% vs. 45.9%, p=0.049). Average adenomas detected per colonoscopy were 1.04 for split prep vs. 0.85 for standard prep (p=NS). Patient satisfaction was higher for split preps. Conclusion: System-wide implementation of a split PEG prep resulted in significantly improved bowel cleansing in VHA patients, particularly in the right colon. Improved bowel cleansing with split preps was associated with higher patient satisfaction.

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Predictors of inadequate bowel preparation for colonoscopy

Cited by 424 publications

References 15 publications

Esophagogastroduodenoscopy-assisted bowel preparation for colonoscopy

Esophagogastroduodenoscopy-assisted bowel preparation for colonoscopy

Efficacy of Morning-Only Compared With Split-Dose Polyethylene Glycol Electrolyte Solution for Afternoon Colonoscopy: A Randomized Controlled Single-Blind Study

Effectiveness of a simplified “patient friendly” split dose polyethylene glycol colonoscopy prep in Veterans Health Administration patients

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