Excellent Cecal Cleansing with Split Dose of Phosphosoda and 30 mg of Bisacodyl – A Retrospective Study Using Cecal Photograph as a Reflector of the Quality of Colon Cleansing

Abstract

Purpose: Poor colon preparation was noted be 18% during an audit of the quality of colonoscopy preparation using polyethylene glycol based (PEG) solution in 2002. Since then, a series of changes have been made to our colon preparation protocol, which reduced the poor preparation rate to 8% & currently to 1%. Cecum appears to be the last to get cleaned out and is often obscured by stools despite excellent cleansing of the rest of the colon. Hence, 300 cecal photographs were graded to assess colon cleansing with different regimens by a single observer to avoid interobserver reporting bias. We also analysed the relationship between the quality of cecal image & colon polyp detection rate. Methods: 100 consecutive colonoscopies in each group were compared. Group A: 1 gallon of polyethylene glycol (PEG) the evening before procedure. Group B: 1.5 ounces phosphosoda (P) the evening before & 1.5 ounces on the day of procedure. Group C: Group B regimen + 10 mg of bisacodyl at noon and the evening before and on the day of procedure (P + BIS). Assessment: The cecal photograph was graded on a scale of 1–3: 1 = stool obscured the mucosa; 2 = 50–100% of mucosa visualized; specs of stool; 3 = Entire (100%) of the mucosa visualized (excellent prep); no stool. Endpoints: Mean colon cleansing (MCC) score & polyp detection for each preparation. Results:Excellent visualization of cecum (Grade 3) – Clean with 100% mucosal visualization: 57% in the split dose of P + 30 mg BIS, 20% in the PEG, & 24% in the split dose of FP (P < 0.001). MCC Score: 2.47 ± 0.69 in the split dose of P + 30 mg of BIS, 1.98 ± 0.71 in the split dose of P, & 1.92 ± 0.6 9 in the PEG respectively, P < .0001. The MCC score was higher in the P+BIS group in men (P < .0001); females (P= 0.04); age < 65 yrs (P < 0.0001) & ≥65 yrs (P < 0.0001). Polyp detection: In the P+BIS group, there was a correlation between the quality of cecal image and polyp detection (P= 0.04). Conclusion: Using the cecal photograph as a reflector of the quality of colon cleansing, the split dose of phosphosoda & 30 mg bisacodyl proved to be superior to other regimens.[figure1]Figure