Split dose and MiraLAX-based purgatives to enhance bowel preparation quality becoming common recommendations in the US

Abstract

Abstract:Objectives: Rates of suboptimal bowel preparation up to 30% have been reported. Liberalized precolonoscopy diet, split dose purgative, and the use of MiraLAX-based bowel preparation (MBBP) prior to colonoscopy are recently developed measures to improve bowel preparation quality but little is known about the utilization prevalence of these measures. We examined the patterns of utilization of these newer approaches to improve precolonoscopy bowel preparation quality among American gastroenterologists. Methods: Surveys were distributed to a random sample of members of the American College of Gastroenterologists. Participants were queried regarding demographics, practice characteristics, and bowel preparation recommendations including recommendations for liberal dietary restrictions, split dose purgative, and the use of MBBP. Approaches were evaluated individually and in combination. Results: Of the 999 eligible participants, 288 responded; 15.2% recommended a liberal diet, 60.0% split dose purgative, and 37.4% MBBP. Diet recommendations varied geographically with gastroenterologists in the West more likely to recommend a restrictive diet (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.16-7.67) and physicians in the Northeast more likely to recommend a liberal diet more likely. Older physicians more often recommended split dosing (OR 1.04, 95% CI 1.04-2.97). Use of MBBP was more common in suburban settings (OR 2.14, 95% CI 1.23-3.73). Evidence suggests that physicians in private practice were more likely to prescribe split dosing (p = 0.03) and less often recommended MBBP (p = 0.02). Likelihood of prescribing MBBP increased as weekly volume of colonoscopy increased (p = 0.03). Conclusions: To enhance bowel preparation quality American gastroenterologists commonly use purgative split dosing. The use of MBBP is becoming more prevalent while a liberalized diet is infrequently recommended. Utilization of these newer approaches to improve bowel preparation quality varies by physician and practice characteristics. Further evaluation of the patterns of usage of these measures is indicated.

The importance of colonoscopy bowel preparation for the detection of colorectal lesions and colorectal cancer prevention

“…An over-the-counter PEG product for the management of constipation (PEG-3550) has also been used for colonoscopy preparation [90,107]. A 2013 survey of gastroenterologists revealed that more than one-third recommended PEG-3550 as a bowel preparation to patients, primarily in suburban settings [113]. PEG-3550 is not osmotically balanced, and electrolyte shifts, particularly hyponatremia, may occur, which could cause complications in patients with certain comorbidities [109].…”

Evaluation of a Systematic Method for Risk Stratification and Management of Gastrointestinal Endoscopy Patients

“…In keeping with our established protocol (Appendix 7) [12], the patient must be NPO for 4 hours prior to the procedure but can have clear liquids prior to that time. The literature suggests that split dose preparations are more effective and better tolerated by patients in general [13,14]. On the other hand patient compliance with split dose prep can be an issue [15].…”

Endoscopy in the Elderly

“…15 Split bowel preparation dosing, whereby the patient is instructed to take half the dose the evening before and the remainder on the morning of the examination, has been more successful because of better visualization of the proximal colon and mitigates the risks of noncompliance, fluid shifts, and renal injury in the elderly. 22,23 SEDATION Procedural sedation during endoscopy remains relatively safe with minimal complications. The general risks of sedation include decreased respiratory drive, aspiration, and a greater likelihood of endoscopic injury.…”