How Often Do We Let Our Patients Have Clear Liquids Up to Two Hours Before Colonoscopy?

Abstract

Introduction: Determine what percentage of endoscopy centers follow recommended guidelines of allowing patients to have clear liquids up to 2 hours prior to colonoscopy. Methods: Colonoscopy preparation instruction sheets available online were collected and reviewed. The following information was noted: type of endoscopy unit - outpatient surgical center or hospital, and fasting time prior to procedure. Questionnaires were sent to endoscopy units to understand the reasons behind the instructions. ASGE has a national program recognizing quality and safety in the practice of GI endoscopy. We also analyzed the practices in the endoscopy units that were recognized by this program. Results: A total of 658 colonoscopy preparation instructions were obtained. Three hundred seventy-eight (57.4%) instructions were from ambulatory surgical centers; 200 (30.4%) were from hospitals, and 75 (11.4%) were from practices that performed procedures at both. Seventy-five (12.7%) allowed patients to have clear liquid up to 2 hours prior to colonoscopy. Three hundred forty-nine (59.3%) allowed clear liquids on the day of procedure (but greater than 2 hours) an average of 4 hours prior. One hundred sixty-five (28%) recommended remaining NPO after midnight prior to procedure. Of the endoscopy units recognized by the ASGE, 42 (11.2%) allowed patients to have clear liquids up to 2 hours prior. Two hundred twenty-nine 229 (61.7%) allowed clears on day of procedure (but greater than 2 hours), an average of 4.1 hours prior. One hundred-four (27.7%) recommended remaining NPO after midnight prior to procedure. The details are given in Figure 1. The reasons for restricting patients to a fasting time greater than 2 hours given by 50 endoscopy units (response rate 24%) included mandates by anesthesia (58%) and little downside to NPO (25%).Figure 1Conclusion: Despite evidence that drinking clear liquids up to 2 hours prior to sedation for colonoscopy is safe and preferred by the patients, most endoscopy units do not follow these recommendations. Their primary concern remains risk of aspiration mostly dictated by anesthesiologists.