Boston Bowel Preparation Score Research Articles

Use of Standardized Educational Video to Overcome Patient Fears and to Improve Colonoscopy Preparation Quality

Introduction: High quality bowel preparation is essential for a successful outpatient colonoscopy. However, 20% of all colonoscopies in the U.S. are limited by suboptimal preparation that can lead to prolonged procedure time, adverse outcomes, and missed lesions. Anxiety regarding the bowel preparation and procedure is reported by up to 30% of patients undergoing outpatient colonoscopy. At present, the use of quality improvement with colonoscopy education video to allay patient fears and improve colonoscopy bowel preparation quality has not been well-studied. We aimed to determine if augmenting traditional patient counseling with a standardized, national GI society-vetted educational video decreases patient anxiety surrounding the colonoscopy procedure and improves bowel preparation quality. Methods: At a single center, patients referred for first time screening colonoscopy were randomized to receive standard pre-procedure counseling per clinic protocol followed by a national GI society-vetted 10 minute video or usual counseling alone. Health literacy was determined using the Rapid Estimate of Adult Literacy in Medicine (REALM) score. Patient-reported anxiety levels on a 1-5 Likert scale were measured on enrollment, after counseling, and immediately prior to the procedure. The endoscopist, blinded to the education method of the patient documented the Boston Bowel Preparation Score following completion of the colonoscopy. Results: 71 patients completed the study (mean age: 52.6 years; 63% male). 29 patients were randomized to the video intervention group (VG) and 42 to the usual counseling group (UC). Mean anxiety scores prior to counseling, after counseling, and on the day of the procedure were similar between the two groups (2.8, 2.4, and 2.4 respectively within the VG and 2.3, 2.0, 2.4 in the UC). Anxiety levels improved for both groups after education and remained lower for the education video group prior to the colonoscopy procedure but the difference was not statically significant. Average Boston Bowel Prep Scores were also similar between groups (6.9 in the VG and 7.2 in the UC). Conclusion: In patients undergoing their first colonoscopy, the use of a second teaching modality for patient counseling with a standardized educational video did not provide an additional benefit in decreasing anxiety or improving the quality of bowel preparation.

Tu1076 A NEW STANDARD: AN OPEN-LABEL TRIAL EXAMINING THE EFFECTIVENESS OF INDIVIDUALIZED WEB BASED COLONOSCOPY PREPARATION INSTRUCTION

Non-pharmalogical factors such as patient education have been shown to significantly improve bowel preparation quality for colonoscopy. For the endoscopist, optimal bowel cleaning increases cecal intubation rates, increases adenoma detection rates, and minimizes necessity for repeat procedures. Following a randomized study demonstrating that the web based patient education tool was superior to traditional paper instructions, this study aims to implement the program at a larger scale; a real life scenario. To determine the effectiveness of web-based pre-colonoscopy instructions for patients, as measured by the percentage of patients achieving an excellent level of colon cleanliness, equivalent to Boston Bowel Preparation Score (BBPS) ≥ 8. Secondary goals were to assess the patient satisfaction and practicality of this means of education being used by the entire GI clinic for all outpatient colonoscopies. Prospective, single center, open label study. Adult outpatients scheduled for non-urgent colonoscopy, aged 19 or greater with English proficiency or an available family member/friend who can translate the instructions for them who have a functioning email account were recruited for this study. Patient demographics, cancellations, and quality of bowel preparation (assessed using Boston and Ottawa Bowel preparation scales) were collected. Patient satisfaction surveys were completed the day of their colonoscopy before their procedure to assess clarity and usefulness of the standardized online instructions. Results: Finalized data analysis (n = 900) shows that 84.5% of patients have achieved a score demonstrating adequacy on the BBPS (mean 7.0; adequate score considered ≥ 6 and 90.1% have scored adequately on the OBPS (mean 3.4; adequate considered ≤ 7). 94.2% of patients scored the web education tool as “Very Helpful” (8 or higher out of 10 on our usefulness scale), and 92.1% scored as “Very Clear” (8 or higher in terms of the clarity of information presented to them). Our analysis suggests that the online instruction pathway is a sufficient alternative to paper instruction, and can be effectively utilized as a standard of care in a real life scenario. Although we did not attain the excellent score (BBPS) ≥ 8, the majority of our preparations were adequately prepared. Our instruction methodology also presents advantages compared to paper because it is uniquely modified for each patient and limits the instruction required by an assistant. Patient satisfaction scales have demonstrated an overwhelming majority of patients who are very satisfied with the clarity and helpfulness of the program.

Tu1061 SAME-DAY SINGLE-DOSE OF 2 LITER POLYETHYLENE GLYCOL IS NOT INFERIOR TO THE STANDARD BOWEL PREPARATIOIN IN AVERAGED-RISK PATIENTS: A RANDOMIZED,CONTROLLED TRIAL

Split dose of 4 Liter (L) polyethylene glycol (PEG) is currently the standard regimen for bowel preparation (BP). However, it may be unnecessary for patients without high risks (e.g. old age, constipation and diabetes etc.) for inadequate bowel preparation. The study aimed to compare the efficacies of bowel cleansing between average-risk patients receiving same-day, single-dose of low-volume (SSL) PEG versus the standard regimen. This prospective, randomized, observer-blinded, non-inferiority study enrolled average-risk patients in three centers. Patients undergoing colonoscopy were randomized (1:1) to the SSL or standard group for BP. The primary outcome was adequate bowel preparation, defined by Boston Bowel Preparation Score (BBPS) ≥6 and each segmental score ≥2. Secondary outcomes included adverse events, cecal intubation rate and patient willingness to repeat BP etc. Among 2532 patients eligible for the study, 940 (37.1%) were at average-risk and 792 (31.3%) at high-risk for inadequate BP. The average-risk patients were randomly allocated to the SSL (n=470) or standard group (n=470). The baseline characteristics between the two groups were similar. Intention-to-treat analysis showed that the adequate rates of bowel preparation were 88.1% in the SSL group and 87.0% in the standard group (RR 1.10, 95%CI: 0.75-1.63, p=0.621).The overall BBPS was 7.3 ± 1.2 and 7.3 ± 1.3 respectively (p=0.948). No significant differences were found between the two groups with regards to the right, transverse and left segmental BBPS (all p>0.05). However, in terms of adverse events, patients in the SSL group reported less nausea (19.6% vs. 29.9%), vomiting (5.3% vs. 11.4%) and abdominal discomfort (2.2% vs. 6.0%) compared with those in the standard group. More patients in the SSL group were willing to repeat bowel preparation (94.0% vs. 89.5%，p=0.015). For average-risk patients, the SSL regime was not inferior to the split-dose of 4L PEG for the adequacy of BP. SSL regime was accompanied with less adverse events. This simplified regime can be suggested as an alternative preparation method for “easy-to prepare” population.Tabled 1Outcomes of bowel preparation and precedure-associated parametersSSL group (n=470)Standard group (n=470)p valueAdequate bowel preparation, n (%)414/470 (88.1%)409/470 (87.0%)0.621Adequate bowel preparation in segmental colon, n (%)Right417/446 (93.5%)411/440 (93.4%)0.957Transverse441/447 (98.7%)433/442 (98.0%)0.422Left437/447 (97.8%)434/445 (97.5%)0.817BBPS, mean (SD)7.3 ± 1.27.3 ± 1.30.948Incorrect diet restriction, n(%)35/449 (7.8%)48/448 (10.7%)0.134Preparation-to-colonoscopy interval ≥8 h, n (%)2/449 (0.4%)6/448 (1.3%)0.177Amount of solution actually taken< 80%, n (%)15/449 (3.3%)33/448 (7.4%)0.007Adverse events, n (%)101/449 (22.5%)189/448 (42.2%)<0.001Willingness to repeat BP, n (%)422/449 (94.0%)401/448 (89.5%)0.015Cecal insertion time (min), mean (SD)6.7 ± 4.76.4 ± 4.00.250Withdrawal time (min), mean (SD)9.0 ± 0.99.0 ± 1.00.456PDR, n (%)208/470 (44.3%)195/470 (41.5%)0.392 Open table in a new tab

Evaluación comparativa de efectividad y tolerabilidad con polietilenglicol y picosulfato de sodio-citrato de magnesio como agentes de preparación intestinal para colonoscopia

Introduction: The effectiveness of colonoscopy depends on multiple factors, being two of the most important ones an adequate bowel preparation and the patient’s tolerability to the preparation. Objectives: Compare effectiveness and tolerability of two bowel preparation agents, polyethylene glycol (PEG) and sodium picosulfate/magnesium citrate (SPMC). Patients and Methods: Randomized clinical trial on outpatients that went into colonoscopy in INDISA Clinic. We evaluated effectiveness and tolerability with Boston Bowel Preparation Score (BBPS) and Lawrence questionnaire [composed by Likert scale, two qualitative questions and Visual Analogue Scale (VAS) for pain], respectively. Results: 189 patients, 123 were randomized to PEG and 66 to SPMC. BBPS average in patients in the PEG branch was 7.51 (SD 1.66) and for SPMC 7.12 (SD 1.71) (p = 0.111). Likert scale for evaluating tolerability average for PEG was 0.94 (SD 0.68) and for SPMC 0.63 (SD 0.61) (p = 0.0004). VAS scale for PEG had an average of 7.68 (SD 2.4) and for PSCM 9.04 (SD 1.59) (p < 0.0001). When we asked for workplace absenteeism, there were no significant differences between both groups and when we asked about using the same intestinal preparation in a future colonoscopy there was statistical significance in favor to SPMC (p = 0.026). Conclusions: No differences were noted on effectiveness between the PEG and SPMC bowel preparations. Nevertheless, SPMC appeared to be better tolerated by patients.

Impact of Colonoscopy Preparation Video on Boston Bowel Preparation Score

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States (US) and the third most common cancer in men and the second most common cancer among women. Early detection of localized adenocarcinoma and adenomatous polyps helps to reduce the mortality related to colon cancer. The CSPY preparation (prep) needs to be optimal. This study's purpose was to determine whether a supplemental educational CSPY video in the viewer's native language would improve bowel preparation, among adult patients at the local county medical facility.Figure: CPRIT colonoscopy preparation video.Figure: Final multivariate analysis results.Methods: Patients who underwent a CSPY were assigned according to whether they watched a supplemental educational video on CSPY bowel preparation in their native language. This video reflects the same information provided in written and verbal form at the time of CSPY scheduling. Bowel prep was rated by the endoscopist using the Boston Bowel Prep Score (BBPS). Participant characteristics and BBPS were collected. Results: There were 186 patients; 91 seen in March 2015 (pre-video) and 95 in March 2016 (postvideo). Mean BBPS was 7.9 and 8.54 for the March 2015 and 2016 group, respectively (P value 0.0039). There was statistical difference between the two groups' racial make-up and BBPS. There was no interaction between gender or race and year effect to account for any difference in that factors' performance. Analyzed data supported a consistent gender effect with females having higher success rates, regardless of video intervention (P value-0.003). After controlling for both gender and race, the year is modestly significant (P value-0.025), with the post-video subjects having higher prep success rates. Conclusion: Only females and Hispanics were found to have a statistically significant relationship as a variable to mean BBPS. There was a strong association with the female gender, when BBPS were viewed dichotomously. Upon multivariate analysis, there was a consistent gender effect with females having higher success rates, regardless of video intervention, and a modest video effect, with the post-video subjects having higher prep success rates. A post-hoc power analysis based on our sample size indicated 76% power to detect differences in BBPS, pre- and post-intervention. Limitations include: 1) no assessment of educational level (Illiteracy rate is 40%), 2) single institution setting, and 3) a short recruiting time frame.

Factors Affecting Effectiveness of Fecal Microbiota Transplant

BackgroundFecal microbiota transplant (FMT) is an effective treatment for relapsing Clostridium difficile infection (CDI). With more widespread use of this intervention, variable cure rates (70–95%) have been observed. We conducted this study to identify specific patient- and procedure-level factors affecting FMT effectiveness, hypothesizing that those patients with higher comorbidity, inadequate bowel preparation, and shorter retention of transplant would fail more frequently.MethodsAt our 2-hospital, >1100-bed community-based academic center, we prospectively followed patients pre/post-FMT between June 2014-April 2017. To undergo FMT, patients must have ≥2 CDI relapses and failed vancomycin taper. We entered all FMT patients into a registry and followed them regularly for up to 1 year, collecting age, Charlson Comorbidity Index, number of CDI relapses, Boston bowel prep score, and stool retention time. FMT donor stool was obtained from OpenBiome (Boston, MA). We defined failure as recurrent CDI requiring treatment ≤8 weeks after FMT. We used 1-sided t-tests to test our hypotheses.ResultsDuring the study period, 41 patients (mean age 65 years, SD 17.6) underwent FMT. Most (37, 90%) were performed via colonoscopy, 1 via upper endoscopy, and 3 via oral preparation (capsules). FMT failure occurred in 10 patients (24.4%). Nearly half (n = 20) reported adverse events, including constipation, gas, abdominal pain, blood in stool, and fatigue. Three patients expired from comorbid disease, and 3 were lost to follow-up. Patients with higher Charlson scores failed more frequently (P = 0.04), and history of tumor (P = 0.03) and pulmonary disease (P = 0.04) were both associated with failure. No other factors, including age, retention time, and Boston bowel prep score, were associated with failure.ConclusionThis study found that patients with multiple comorbid conditions, as defined by the Charlson index, are at risk for FMT failure. However, quality of bowel prep and retention time did not predict FMT failure. Future studies should include larger samples of FMT patients to determine whether specific comorbidities such as history of tumor and pulmonary disease are clinically significant predictors of FMT failure.Disclosures All authors: No reported disclosures.

The Obese Patient: Effects of Split-dose Preparation During Colonoscopy on Adenoma Detection Rate

Introduction: Obesity is associated with an increased risk of colorectal cancer. A study by Grewal, et al showed that adenoma detection rate (ADR) is higher among overweight and obese males compared to their normal weight counterparts, suggesting a higher prevalence of precancerous adenomas in this population. ADR, however, is not a direct measure of adenoma prevalence because of its dependence on colonoscopy quality, including the quality of the bowel prep. Obesity is an independent risk factor for suboptimal bowel prep, suggesting that ADR may significantly underestimate adenoma prevalence in this group. Because split-dose bowel prep is associated with improved bowel prep scores, our aim was to determine if split-dose bowel prep is also associated with higher ADR among obese patients. Methods: This study utilized prospectively collected data at point-of-care using Qualoscopy (Docbot, Inc). Inclusion criteria was all obese patients, defined as a BMI ≥30, who had colonoscopies performed for any indication at our outpatient facilities from June, 2012 to April, 2017. Statistical analysis was performed using chi-square and two-sample t-test. For reference, the same measures were analyzed in normal/underweight (< 25) and overweight BMIs (25-29.9). Results: Of 1419 colonoscopies performed among obese patients, 856 (60.3%) received split-dose bowel prep and 563 (39.7%) received single-dose prep. The split-dose group was weighted towards female patients, but there were no significant differences in BMI, gender, or primary indication (table 1). ADR was significantly higher among those who received split-dose (50.7% vs 38.4%, p < 0.001). Similarly, adequate bowel prep (defined as a Boston Bowel Prep Score ≥8) was significantly more frequent in the splitdose compared to single-dose groups (72% vs 60%, p < 0.001). The degree of benefit of split-dose prep, as measured by % improvement in ADR and % improvement in fraction of adequate preps, was highest in obese patients compared to those who were normal/underweight or overweight (table 2).Table: Table. Patient DemographicsTable: Table. Outcomes Based on BMI and Bowel Preparation UsedConclusion: Our data shows that split-dose bowel prep in obese patients is associated with significantly higher ADR and percentage of patients with adequate prep. Furthermore, these benefits of split-dose prep were most pronounced among the obese population. Based on compelling evidence that higher ADRs are associated with lower interval cancer rates, our data supports widespread use of split-dose prep in this high-risk population.

Use of Peppermint Oil During Screening Colonoscopy to Improve Visibility

Introduction: Colonoscopy is the fundamental screening tool used to detect colorectal polyps and colorectal cancer. Many techniques are being developed to increase visualization and improve adenoma detection rate (ADR). Antispasmodic agents are used in intravenous form to inhibit peristalsis during colonoscopy. Limited data suggest beneficial effects of topical administration of peppermint oil, containing L-menthol, including diminished smooth muscle contraction, decreased endoscopic procedural time and improved ADR. We aimed to assess whether use of peppermint oil during screening colonoscopy improves visualization and increases patient satisfaction, as well as ADR. Methods: This was a randomized, double-blind, placebo-controlled study. Patients scheduled for screening colonoscopy were randomly assigned to either receive peppermint oil or placebo. Insertion of the colonoscope to the cecum was performed as standard practice and, once in the cecum, 50ml of peppermint oil solution or placebo containing normal saline was gently sprayed into the lumen. During withdrawal, the endoscopist graded colonic peristalsis, spasticity, and visibility while assessing for colon lesions. Quality measures including bowel preparation, withdrawal time and number of polyps removed were recorded. Additional data on demographics and procedural details were documented and analyzed. Statistical analysis was performed using Wilcoxon rank sum and Chi-square tests. Results: Preliminary data from 28 patients were analyzed. Thirteen patients were randomized to receive peppermint oil. Age, gender, and BMI were comparable between the two groups. Average Boston Bowel Preparation Score was overall excellent (mean 7.9 ±1.2 for drug vs 8.3 ±1.0 for placebo). Withdrawal time tended to be less in the group that received the drug (9.8 min vs. 10.9 min) with shorter overall procedure time (18.3 min vs 21.7 min, p= 0.56). With use of peppermint oil, ADR was 32.1% compared with 37.5% in controls (p=0.37). Assessment of spasticity, peristalsis and visualization did not differ in the two groups. Patient satisfaction evaluated by perception of pain and willingness to repeat the procedure was equally high in both groups. Conclusion: Our initial data on the use of peppermint oil in screening colonoscopy suggests no significant impact on peristalsis, patient satisfaction, or ADR. Decrease in procedure time may be a surrogate marker for improved visibility with additional patients currently being recruited to further explore our hypothesis.

Perfect Boston Bowel Preparation Score and Adenoma Detection Rate: Air Insufflation versus Water Exchange Colonoscopy

Perfect Boston Bowel Preparation Score and Adenoma Detection Rate: Air Insufflation versus Water Exchange Colonoscopy

Factors Affecting Boston Bowel Preparation Score

Factors Affecting Boston Bowel Preparation Score

Abstract 11 Assessing the Success of a Multidisciplinary Quality Improvement Initiative to Improve Outpatient Screening Colonoscopy Bowel Preparation

The quality of screening colonoscopy preparation is dependent upon pre-procedural bowel preparation. An abundance of poor and fair bowel preparations during screening colonoscopies at our tertiary care, a university ambulatory endoscopy center, prompted a quality improvement (QI) initiative to enhance screening colonoscopy quality and efficiency. A multidisciplinary team comprising Gastroenterology faculty and fellows, endoscopy nurses, and procedure schedulers was assembled. Current scheduling workflow, screening colonoscopy bowel preparation protocols, patient informational handouts, and relevant published literature were reviewed. Several changes were implemented: prescribed bowel preparations were standardized into 1 of 2 choices ‘Standard Bowel Prep’: split-dose 4L polyethylene glycol solution, or ‘Miralax Plus Prep’: 5 days of polyethylene glycol 3350 (MIRALAX) 17g twice daily plus the Standard Bowel Prep. The latter was chosen for prior poor bowel preparation, opioid use, or chronic constipation. Standardized dietary instructions were used; patients were asked to avoid corn, beans, and vegetables for 3 days. A simple, colorful, pictorial description of a clear liquid diet was designed. The procedure schedulers and endoscopy nurses received additional training on educating patients about effective bowel preparation, with the use of newly designed visual aids. Endoscopists applied the validated Boston Bowel Preparation Score (BPSS) to grade the bowel preparation immediately post procedure. χ2 test for proportions and paired t-test for means were used to test for statistical significance. Records of 776 consecutive patients who had screening colonoscopy between January—August 2016 were reviewed; 388 prior to the QI initiative implementation date (April 21 2016), and 388 post-intervention. Males and females were equally represented (388 each). Post intervention, the mean Boston Bowel Preparation Score (BBPS) was 7.3, corresponding with excellent bowel preparation. Over half (52%) of post-intervention bowel preparations received a perfect score of 9. There was a significant increase in optimal (good + adequate + excellent) bowel preparations (63.3% to 82.4%), and a corresponding drop in fair (23.8% to 13.9%) and poor (13.9% to 3.6%) post-intervention. The number of aborted procedures because of suboptimal bowel preparation decreased from 13 pre-intervention to 5 (P = .03; Table 1). The mean procedure duration of screening colonoscopies without polypectomy was significantly lower post-intervention compared with pre-intervention group (from 16.4 minutes to 15.1 minutes; P = .04). This QI initiative demonstrates that a multifaceted approach to improving the quality of colonoscopy preparation can be executed in a brief time. The multidisciplinary team implemented standardized bowel preparations, dietary counseling, and pictorial dietary reinforcement, which improved the quality of screening colonoscopy bowel preparations and reduced both the number of aborted procedures as well as duration of screening colonoscopy without polypectomy.

Abstract 9 A Good Bowel Prep, Can We as Physicians do Better?

Colorectal cancer (CRC) is a leading cause of cancer death in the US and high-quality colonoscopy is key to efficient CRC screening and detection. Previous studies indicated that 18% to 31% of patients have inadequate bowel preparation. It has been reported that nearly 20% of patients with poor bowel preparation fail to follow instructions. We hypothesized that educating physicians who order colon purgatives with general tips on good quality bowel cleansing will improve the adequacy of preparation by helping to choose the most appropriate protocol tailored to each patients’ medical comorbidities. The aim of this quality improvement project was to determine whether a teaching intervention for ordering primary care physicians improves the patient’s bowel preparation quality and changes prescribing habits. This was a prospective cohort study. Physicians ordering colonoscopies in primary care practices were provided with a brief informational session regarding the available bowel cleansing agents and useful tips for a good bowel prep. Patients undergoing a screening or diagnostic colonoscopy 3 months prior to the intervention and 3 months after completion of the teaching intervention were identified by reviewing endoscopy records. Outpatient charts were reviewed to record demographics and additional data on patient factors. Differences between continuous variables were assessed using analysis of variance for multiple group comparisons or the Student t-test for comparisons between the 2 groups. The χ2 test was used to assess differences in distributions of categorical variables. A total of 192 patients underwent screening or diagnostic colonoscopies 3 months preceding the teaching intervention compared with 175 patients afterwards. Gender, body mass index, ethnicity, and patient factors (Table 1) were comparable between the 2 groups, except for a slightly older population (mean age, 64.8 vs 60.8 years) present in the pre-intervention group. Bowel prep quality overall was good in both groups as assessed by the total Boston Bowel Prep Score (BBPS, 6.64 vs 6.66) and only 9 compared with 8 patients who had inadequate preparation (BBPS < 5) pre- and post-intervention, respectively (NS). Additional measures of quality, such as segmental BBPS scores and withdrawal time, did not show a marked improvement after intervention. The majority of physicians prescribed large volume purgatives (GoLytely, MoviPrep) with the preferred split dosing (Table 2). In a multivariate analysis, only patient factors were predictive of inadequate bowel preparation quality (BBPS <5) (P = .0029). Inadequate bowel preparation is a common problem with potential impact on colorectal cancer screening quality. In our cohort, provider education had no measurable impact on bowel prep quality, which was already adequate in most patients before our proposed intervention. However, our negative findings on the role of provider education may not translate into all practice settings. Furthermore, patient-related risk factors were predictive of worse bowel prep quality, indicating the importance of tailoring our colon prep prescribing practices by these parameters to achieve high-quality colonoscopy.Table 1Pre-InterventionPost-InterventionP valueMeanStd DevMeanStd DevAge (y)64.779.8260.8310.19<.001BMI28.074.8227.825.13.63GenderN% totalN% total.72 Female9826.70%8623.43% Male9425.61%8924.25%Ethnicity.07 White16444.69%15141.14% Black41.09%51.36% Asian30.82%102.72% Hispanic133.54%61.63% Other82.18%30.82%Patient factors.45 Type 2 diabetes mellitus246.76%195.35% Narcotic use10.28%51.41% Constipation154.23%113.10% Prior colon surgery30.85%20.56% BBPS (total score)6.641.266.661.30.88 BBPS < 5 inadequate92.47%82.19%.94 BBPS ≥ 5 inadequate18149.59%16745.75% BBPS right2.120.532.140.56.71 BBPS transverse2.350.532.310.51.44 BBPS left2.180.562.250.51.22 Number of polyps1.741.951.602.11.51 Cecal intubation10.557.7011.537.61.22 Withdrawal in13.507.1714.539.23.24Procedure Time25.259.8926.2912.78.39 Open table in a new tab Table 2Pre-InterventionPost-InterventionN% totalN% totalBowel prep used.19 GoLytely6317.17%6617.98% MoviPrep12734.60%10528.61% Suprep00.00%30.82% Prepopik20.54%10.27%Split dose?.19 Yes16645.23%15943.32% No267.08%164.36% Open table in a new tab

Boston Bowel Preparation Segment Scores of 0 and 1 Associated with Missed Polyps

The Boston Bowel Preparation Score (BBPS) is a validated, clinically useful score for colonoscopy cleansing. It is increasingly accepted that scores of

Endoscopy Lower.

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A Comprehensive Intervention to Enhance Inpatient Colon Preparation Quality and Efficacy for Colonoscopy: 2016 ACG Presidential Poster Award

Introduction: Safety, accuracy and utility of colonoscopy requires adequate colon preparation. This is particularly important for inpatients undergoing colonoscopy for acute diagnostic or therapeutic indications. Inadequate inpatient colon preparation has been associated with longer hospital length of stay and increased hospital costs. We report implementation of a quality improvement intervention to improve the quality of inpatient colon preparations. Methods: Reports from inpatient colonoscopies performed over 12 months were reviewed to assess baseline colon preparation quality as determined by the Boston Bowel Prep Score (BBPS). A comprehensive intervention to improve colon preparation quality was subsequently developed. The intervention had multiple, simultaneously-implemented, components including: Standardized, EMR-based, colonoscopy preparation order set (Figure 1); Automated EMR alerts to prompt nursing assessment of colon preparation progress; Standardized nursing charting processes for tracking progress of colon preparation (Figure 2); Standardized education for nursing staff and ordering providers on importance of adequate colon preparation, assessment of colon preparation quality, and use of the above processes; Use of standardized patient education materials. A 10-week pilot implementation of the intervention was undertaken and postintervention colon preparation quality assessed.Figure 1Figure 2Results: 239 inpatient colonoscopies were performed in the preintervention assessment period. Mean preintervention total BBPS was 6.7 (2.3 in left colon, 2.3 in transverse colon, 2.1 in right colon) and 22.5% of patients (n=54) had inadequate colon preparation (total BPPS < 6 or BPPS < 2 in any segment). 10 weeks after pilot implementation of the quality improvement intervention, colon preparation quality data was available on 31 patients. Of these, 6.5% of patients (n=2) had inadequate colon preparation. Mean postintervention total BBPS was 7.6 (2.6 in left colon, 2.7 in transverse colon, 2.3 in right colon), representing a 13.4% improvement in total BPPS following implementation of the quality improvement intervention. Conclusion: Use of a comprehensive colon preparation quality intervention resulted in improved inpatient colon preparation quality in this pilot implementation. The intervention is being implemented hospital-wide. The EMR-based processes and patient education materials are being refined. Data collection on colon preparation quality, hospital length of stay, and hospital costs is ongoing.

Safety and Efficacy of a Same-Day Low-Volume 1L PEG Bowel Preparation in Colonoscopy for the Elderly People and People with Renal Dysfunction.

A same-day low-volume 1L polyethylene glycol (PEG) for bowel preparation before colonoscopy was developed to improve patients' compliance. We aimed to evaluate the efficacy and safety of this regimen especially for the elderly and patients with renal dysfunction. All consecutive patients who underwent colonoscopy in our center from November 2014 to September 2015 were included. Patients undertook a low-residue diet with 10mL sodium picosulfate 1day before colonoscopy. Subsequently, they had 1L low-volume PEG (MoviPrep) and 0.5L water 4h before the examination. Clinical outcomes, including cleansing level using the Boston bowel preparation score (BBPS), in the elderly and special-elderly (65-79 and ≥80years old) were analyzed and compared with the non-elderly (18-64years old). Additionally, patients with renal dysfunction were analyzed with respect to both complications and changes in blood parameters. A total of 5427 patients (mean age: 64.5±13.8) were analyzed. The rate of BBPS≥6 in the elderly (2761 patients), special-elderly (565 patients), and non-elderly (2101 patients) was 94.1, 91.8, and 94.6%, respectively. In the special-elderly, the rate of renal dysfunction was 14.8%, and no severe complications were detected after colonoscopy. Additionally, there were no severe complications in 86 patients with renal dysfunction, though elevation of hematocrit was shown after intake of 1L PEG (before, 36.7±6.1 vs. after, 39.0±5.7, P=0.006). Our study shows the safety and efficacy of same-day low-volume 1L PEG bowel preparation in colonoscopy for the elderly and patients with renal dysfunction.

Sa1061 In the Era of Split Dose Bowel Preparation, Does Volume Matter? The Impact of Low Volume Split Dose Preparation Versus Large Volume Split Dose Preparation on Boston Bowel Preparation Score (BBPS)

Sa1061 In the Era of Split Dose Bowel Preparation, Does Volume Matter? The Impact of Low Volume Split Dose Preparation Versus Large Volume Split Dose Preparation on Boston Bowel Preparation Score (BBPS)

Boston Bowel Prep Score ≥2 in Each Segment Defines Adequate Preparation

Recent guidelines recommend that colonoscopists should achieve adequate bowel preparation in ≥85% of patients and define an adequate preparation as including appropriate surveillance or screening interval recommended for the findings of the examination. Previous studies suggest that a Boston Bowel Preparation Score (BBPS) of ≥5 predicts that doctors will follow recommended intervals, but many clinicians insist on a score of at least 2 in each segment. In a prospective observational study, investigators sought …

Randomized-Controlled Trial Comparing Adenoma Detection Rate Using Water Exchange Versus Air Insufflation Colonoscopy in a U.S. Community-Based Setting

Introduction: Efforts are underway to improve adenoma detection rate during screening colonoscopies, especially in the right colon. Water exchange colonoscopy has demonstrated promising results, purportedly by better cleansing of the colon, and has also resulted in less patient discomfort. Majority of these studies were conducted in a predominantly male and Caucasian VA population. We report the first community-based RCT in the USA that includes female and minority populations, comparing water exchange with air insufflation method in assessing adenoma detection rate. Methods: A prospective sample of 178 patients above 50 years of age presenting for screening and surveillance colonoscopies at a community-based endoscopy center, with no personal or family history of colon cancer, familial polyposis syndromes, inflammatory bowel disease, or prior history of colonic surgery, who consented for the study were blinded and randomized to either water exchange (n=88) or air insufflation colonoscopy (n=88). Four endoscopists participated in the trial. All patients received adequate sedation prior to scope insertion, followed by sequential doses as needed. All patient received a split bowel prep. Prep quality was assessed by the Boston Bowel Prep Score. Post-procedure pain and recovery time were assessed by a nurse blinded to the colonoscopy technique. All colon polyps were assessed by expert GI pathologists. Sessile serrated lesions were reported when found. Advanced adenomas were defined as villous or tubulovillous in histology, or size > 1 cm. Adenomas found proximal to splenic flexure were reported as proximal adenomas. Results: Of 178 patients, 3 were excluded from final analysis, 1 in the air group diagnosed with FAP, and 2 in the water group requiring switch to pediatric colonoscopes due to tortuous sigmoids. There were no statistically significant differences between the 2 groups in terms of sex, race (Caucasian, Black, Hispanic, Asian), age, BMI, alcohol and tobacco use, bowel prep quality, sedation requirement, abdominal pressure application, patient position change, endoscope stiffner use, or scope length at cecum. The cecum was intubated in all patients. Conclusion: Water exchange colonoscopy is a viable technique in a busy community-based endoscopy center. It demonstrated a trend towards higher polyp, adenoma, sessile serrated lesion and advanced adenoma detections. It resulted in significantly lower post procedure pain and recovery time, without significantly increasing procedure time.Table 1: Baseline patient characteristicsTable 2: Polyp detection rates, procedure and recovery times, and post procedure pain

Hospital Length of Stay Can Be a Predictor of Bowel Preparation Quality in Hospitalized Patients: Results of a Pilot Study in a Tertiary Care Teaching Hospital

Introduction: Aim: To identify the predictive factors for poor bowel preparation quality in hospitalized patients at a tertiary care hospital. Methods: Nursing staff and endoscopists assessed bowel preparation quality using the Boston Bowel Preparation Score after inpatient colonoscopies. We looked for potential predictors of poor bowel preparation scores. We reviewed patients' charts and examined their age, gender, h/o prior colonoscopy, length of hospitalization, h/o opiate use, BMI, h/o dementia or psychiatric illness, h/o constipation, h/o prior abdominal surgery, procedure type (i.e. colonoscopy vs colonoscopy with EGD), hospital unit, and number of medications. Data was analyzed utilizing SPSS software. Results: Twenty-eight forms were filled out during a pilot period evaluating 24 patients. For the 4 patients who had 2 forms completed, inter-rater reliability was 100%, so no averaging of scores was needed. BBPS scores ranged from 3 to 9. Nearly a third of the patients (29%, n=7) had a score of 3 while only 8% (n=2) had a perfect score of 9. Seven patients (29%) had a BBPS score of 7 or higher. When analyzing the subscores of the R-sided, transverse and L-sided colon, BBPS scores became lower as the colon segment became more proximal. The number of full subscores (i.e. excellently prepped) awarded decreased from 33% (n=8) in the left colon to 17% (n=4) in the transverse colon to 8% (n=2) in the right colon. For the analysis of predictive variables, 23 patients were analyzed as one patient had an invalid medical record number recorded. After running a 1-tailed Pearson correlation, these were gender (r = .355, p = 0.048, with females prepping better), length of stay (r = -0.364, p = 0.044), and number of medications (r = -.432, p = 0.020) found to be significant. Younger age trended toward better bowel preps, but this did not reach significance (r = -0.313, p = 0.073). A forced-entry multiple regression was conducted on these four factors; the factors explained a significant amount of variance in bowel prep quality (R2 = 0.427, F(4,18) = 3.359, p = 0.032). In terms of individual factors, only length of stay significantly predicted bowel prep quality (β = -0.14, p = 0.037). Conclusion: Our study suggests that hospital length of stay could be utilized as a predictor of patients that may need additional time or bowel prep for optimal inpatient colonoscopy. This may be useful in avoiding repeat colonoscopies due to poor preparations which can lengthen hospital stays.