Strategies to Improve Inadequate Bowel Preparation for Colonoscopy

Hernández, Goretti; Gimeno–García, Antonio Z.; Quintero, Enrique

doi:10.3389/fmed.2019.00245

Cited by 21 publications

(13 citation statements)

References 64 publications

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“…In the past decade, several systems have been introduced to the market to aid intraprocedural colon cleansing in patients who are found to be poorly prepared at the time of colonoscopy [ 14 ]. However, these devices have been limited by several factors: (1) they do not create multiple high intensity pulsatile water jets that can emulsify fecal matter, (2) They cannot simultaneously irrigate and suction debris from the colon, (3) they are used through the working channel of the colonoscope and can compromise the ability to suction fluid from the colon lumen, (4) the device has to be inserted and removed during the procedure in order to allow for evacuation of fluid and therapeutic maneuvers, thereby lengthening the procedure time.…”

Section: Discussionmentioning

confidence: 99%

A multicenter, prospective, inpatient feasibility study to evaluate the use of an intra-colonoscopy cleansing device to optimize colon preparation in hospitalized patients: the REDUCE study

et al. 2021

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Background High quality bowel preparation prior to colonoscopy can be difficult to achieve in the inpatient setting. Hospitalized patients are at risk for extended hospital stays and low diagnostic yield due to inadequate bowel preparation. The Pure-Vu System is a novel device intended to fit over existing colonoscopes to improve intra-colonoscopy bowel preparation. The objective of the REDUCE study was to conduct the first inpatient study to evaluate optimization of bowel preparation quality following overnight preparation when using the Pure-Vu System during colonoscopy. Methods This multicenter, prospective feasibility study enrolled hospitalized subjects undergoing colonoscopy. Subjects recorded the clarity of their last bowel movement using a 5-point scale prior to colonoscopy. After one night of preparation, all enrolled subjects underwent colonoscopy utilizing the Pure-Vu System. The primary endpoint was improvement of colon cleanliness from baseline to post-cleansing with the Pure-Vu System as assessed by the improvement in Boston Bowel Preparation Scale (BBPS). An exploratory analysis was conducted to assess whether the clarity of the last bowel movement could predict inadequate bowel preparation. Results Ninety-four subjects were included. BBPS analyses showed significant improvements in bowel preparation quality across all evaluable colon segments after cleansing with Pure-Vu, including left colon (1.74 vs 2.89; p < 0.0001), transverse colon (1.74 vs 2.91; p < 0.0001), and the right colon (1.41 vs 2.88; p < 0.0001). Prior to Pure-Vu, adequate cleansing (BBPS scores of ≥ 2) were reported in 60%, 62%, and 47% for the left colon, transverse colon, and right colon segments, respectively. After intra-colonoscopy cleansing with the Pure-Vu System, adequate colon preparation was reported in 100%, 99%, and 97% of the left colon, transverse colon, and right colon segments, respectively. Subjects with lower bowel movement clarity scores were more likely to have inadequate bowel preparation prior to cleansing with Pure-Vu. Conclusions In this feasibility study, the Pure-Vu System appears to be effective in significantly improving bowel preparation quality in hospitalized subjects undergoing colonoscopy. Clarity of last bowel movement may be useful indicator in predicting poor bowel preparation. Larger studies powered to evaluate clinical outcomes, hospital costs, and blinded BBPS assessments are required to evaluate the significance of these findings. Trial registration Evaluation of the Bowel Cleansing in Hospitalized Patients Using Pure-Vu System (NCT03503162).

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Section: Discussionmentioning

confidence: 99%

A multicenter, prospective, inpatient feasibility study to evaluate the use of an intra-colonoscopy cleansing device to optimize colon preparation in hospitalized patients: the REDUCE study

et al. 2021

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“…It is important to educate patients about bowel preparation prior to colonoscopy procedures in order to ensure their compliance with medication intake and dietary restrictions, thereby increasing the quality of the procedure (Guo et al, 2017;Hernández et al, 2019;Kastenberg et al, 2018;Quaresma et al, 2018). Patients require such guidance not only to ensure effectiveness, but also to avoid complications that could occur during preparation (Kastenberg et al, 2018;Quaresma et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Patients require such guidance not only to ensure effectiveness, but also to avoid complications that could occur during preparation (Kastenberg et al, 2018;Quaresma et al, 2018). This guidance entails procedural instructions, information regarding how the examination will be conducted, associated risks, potential complications, benefits, discomforts, and preparatory factors, such as required medications and dietary considerations (Guo et al, 2017;Hernández et al, 2019;Kastenberg et al, 2018;Quaresma et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Ingested medications must, therefore, be low-cost, have a pleasant taste, require a minimal period of time between ingestion and elimination, and be designed to minimize discomfort and/or avoid significant changes in fluid/ electrolyte levels (Guo et al, 2017;Hernández et al, 2019;Kaiser-Júnior et al, 2018). Inadequate preparation can lead to unsuccessful examinations, impaired polyp detection, increased examination time, complications, an increased probability of procedural repetition, delayed patient treatment, and increased colonoscopy-related costs (Guo et al, 2017;Hernández et al, 2019;Kastenberg et al, 2018). However, current literature shows that nurse-led guidance on bowel preparation prior to colonoscopy is associated with significantly improved results (Andrade et al, 2017;Carvalho et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

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Telephonic Nurse Guidance for Colonoscopy: A Clinical Trial

et al. 2021

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This study aims to analyze the effectiveness of nurse-conducted telephone guidance for bowel preparation before a colonoscopy after patients have received routine recommendations. A randomized, controlled, colonoscopist-blinded clinical trial was conducted at a Brazilian teaching hospital. Participants included patients aged ≥ 18, who were available via telephone (the intervention group was given guidance over telephone). Of the 109 total participants, 55 were placed into the intervention group (IG) and 54 into the control group (CG). Outcomes included Boston Bowel Preparation Scale (BBPS) scores, adenoma detection, and cecal intubation. Total BBPS scores showed a statistically significant reduction for the IG when compared to the CG ( p < .001) (all colon segments were evaluated thus). Cecal intubation occurred in all exams for those in the IG ( p = .027). No significant differences were found regarding adenoma detection. The examined educational intervention was an effective strategy for reeducating patients about bowel preparation.

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“…In particular, constipation increases the risk of inadequate BP about twofold [ 5 , 6 ]. For cases with these risk factors, we regularly strengthen the method of BP, such as increasing the amount of polyethylene glycol (PEG), adding a laxative before the procedure, and performing strict diet limitation [ 7 ]. Regarding the addition of a laxative, bisacodyl, sennoside, picosulfate sodium, magnesium oxide, and short-duration PEG are prescribed in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Short-Duration Polyethylene Glycol plus Electrolytes for Improving Bowel Preparation of Colonoscopy in Patients with Chronic Constipation

Yoshida

Inagaki

Fukumoto

et al. 2020

Gastroenterology Research and Practice

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Backgrounds and Aims. Sachets of polyethylene glycol plus electrolytes (PEG+E: Movicol: EA Pharma, Tokyo, Japan) are used for chronic constipation, and its efficacy is reported only for female and nonelderly people. Chronic constipation is one of the reasons of poor colonoscopic bowel preparation (BP). We analyzed its efficacy in improving chronic constipation and poor colonoscopic BP related to it, including male and elderly people. Materials and Methods. This multicenter retrospective study was conducted from September 2019 to September 2020 at 5 related institutions among patients ≥ 20 years old diagnosed with chronic constipation whose previous colonoscopic BP had had a fair or poor Aronchick score. Two or four sachets of PEG+E (13.7 or 27.4 g/day) were prescribed for 1 week before colonoscopy. We analyzed the rate of improvement in BP, effect-related factors, spontaneous bowel movements (SBMs), stool consistency, improvement of constipation symptoms, and adverse events. Results. We evaluated 106 cases (56 males) with an average age of 69.5 ± 9.4 years old (≤74 years old: 68 cases, ≥75 years old: 38 cases). The improvement rate of BP was 72.6%, and the insertion time and pain score also improved. A performance status of 1 or 2 was associated with poor BP. SBMs (times/week) increased from 4.0 ± 1.9 to 6.1 ± 2.6 ( p < 0.001 ). The overall improvement rates of SBMs, stool consistency, symptoms of constipation, and rate of adverse events were 58.5%, 90.6%, 59.4%, and 6.6%, respectively, showing no significant differences with regard to age or gender. Conclusions. Short-duration PEG+E was effective for improving poor BP and chronic constipation.

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Strategies to Improve Inadequate Bowel Preparation for Colonoscopy

Cited by 21 publications

References 64 publications

A multicenter, prospective, inpatient feasibility study to evaluate the use of an intra-colonoscopy cleansing device to optimize colon preparation in hospitalized patients: the REDUCE study

A multicenter, prospective, inpatient feasibility study to evaluate the use of an intra-colonoscopy cleansing device to optimize colon preparation in hospitalized patients: the REDUCE study

Telephonic Nurse Guidance for Colonoscopy: A Clinical Trial

The Efficacy of Short-Duration Polyethylene Glycol plus Electrolytes for Improving Bowel Preparation of Colonoscopy in Patients with Chronic Constipation

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