Split‐dose bowel preparation with polyethylene glycol for colonoscopy performed under propofol sedation. Is there an optimal timing?

Alghamry, Alaa; Ponnuswamy, S.; Agarwal, Aditya; Moattar, H.; Yerkovich, Stephanie T.; Vandeleur, Ann; Collaborative, Endoscopy Nurses; Thomas, James A.; Croese, John; Rahman, Tony; Hodgson, Ruth

doi:10.1111/1751-2980.12458

Cited by 6 publications

(5 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly, fasting time before adult colonoscopy is being widely reduced due to the popularity of superior split-and large-volume bowel preparations in which the last dose is typically completed 3 hours before the procedure. Such shorter fasting does not increase gastric volume or acidity [75][76][77][78], and does not appear to increase aspiration risk during the associated propofol deep sedation or anaesthesia [75][76][77][78][79].…”

Section: Absent Risk Factorsmentioning

confidence: 97%

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

Green¹,

et al. 2019

View full text Add to dashboard Cite

The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The literature evidence is clear that fasting, as currently practiced, often substantially exceeds recommended time thresholds and has known adverse consequences, for example, irritability, dehydration and hypoglycaemia. Fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. The probability of clinically important aspiration during procedural sedation is negligible. In the post-1984 literature there are no published reports of aspiration-associated mortality in children, no reports of death in healthy adults (ASA physical status 1 or 2) and just nine reported deaths in adults of ASA physical status 3 or above. Current concerns about aspiration are out of proportion to the actual risk. Given the lower observed frequency of aspiration and mortality than during general anaesthesia, and the theoretical basis for assuming a lesser risk, fasting strategies in procedural sedation can reasonably be less restrictive. We present a consensus-derived algorithm in which each patient is first risk-stratified during their pre-sedation assessment, using evidence-based factors relating to 374 This statement presents the first fasting and aspiration prevention recommendations specific to procedural sedation.

show abstract

Section: Absent Risk Factorsmentioning

confidence: 97%

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

Green¹,

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Similarly, consumption of split-dose bowel prep within 3 to 4 hours of propofol sedation has not shown to increase risk of aspiration. 94…”

Section: Sedation-related Aesmentioning

confidence: 99%

ASGE review of adverse events in colonoscopy

Kothari

Huang

Shaukat

et al. 2019

Gastrointestinal Endoscopy

131

111

View full text Add to dashboard Cite

“…However, it is not just endoscopists who have a role in this improvement. For example, even though studies have demonstrated that residual gastric volume is not higher with a split-dose regimen when the last dose of preparation is consumed at least 3 hours before the colonoscopy 23 24 25 26 , in our study, anesthesiological concerns seem to be relevant in hampering the adoption of a split-dose regimen.…”

Section: Discussionmentioning

confidence: 56%

IMPlementing split Regimen OVEr Single dose using a Plan-Do-Study-Act approach (IMPROVES study)

et al. 2019

View full text Add to dashboard Cite

Background and aims A split-dose regimen for colonoscopy is recommended by international guidelines, but its adoption is still suboptimal. Our aim was to assess whether a Plan-Do-Study-Act approach (PDSA), a scientific method promoting quality improvement, would be able to improve adherence to a split-dose regimen, and to identify factors influencing its adoption. Methods This study consisted of three phases: Cycle 1: a cross-sectional assessment of split-dose adherence in consecutive outpatients/inpatients undergoing colonoscopies in 74 Italian centers; Educational intervention: regional meetings with literature review, analysis of Cycle 1 data, and discussion on corrective measures; local diffusion of educational material and tools for improvement; Cycle 2: reassessment of split-dose adherence after spontaneous local interventions. Demographic, clinical, and procedural variables were systematically collected. Multivariate logistic regression was used to identify predictors of split-dose adoption. Results In total, 8213 patients (mean age = 60.29 years (SD = 13.58), men = 54 %, outpatients = 88.4 %) were enrolled between 2013 and 2016 (Cycle 1 = 4189 patients and Cycle 2 = 4024 patients). Split-dose adoption rose from 29.1 % in Cycle 1 to 51.1 % in Cycle 2 ( P < 0.0001), and being enrolled in Cycle 2 independently predicted split-dose adherence (OR = 2.9; 95 %CI 2.6 – 3.3). The adoption improved in all time slots, including colonoscopies scheduled before 0930. The main corrective measures were: rescheduling of colonoscopies after 0930 (between 0930 and 1130: OR = 2.6; 95 %CI 2.3 – 3.1; after 1130: OR = 7; 95 %CI 5.9 – 8.4); the cleansing regimen communicated by the Endoscopy unit (via form: OR = 1.6; 95 %CI 1.3 – 1.9; via visit: OR = 2.1; 95 %CI 1.7 – 2.5); a decrease in the use of deep sedation (OR = 2; 95 %CI 1.7 – 2.5). Conclusions An educational intervention with observation-driven corrections through a PDSA approach was able to substantially increase the adoption of a split-dose regimen.

show abstract

Split‐dose bowel preparation with polyethylene glycol for colonoscopy performed under propofol sedation. Is there an optimal timing?

Abstract: The consumption of bowel preparation agent within 3-4 h before propofol sedation resulted in a similar RGV and pH as those achieved by more prolonged fasting, with no increased risk of aspiration even in patients perceived to be at high risk.

Cited by 6 publications

References 50 publications

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

ASGE review of adverse events in colonoscopy

IMPlementing split Regimen OVEr Single dose using a Plan-Do-Study-Act approach (IMPROVES study)

Contact Info

Product

Resources

About