Boston Bowel Preparation Score Research Articles

334 ANNIE Text Messaging Protocol to Improve Outpatient Colonoscopy Bowel Preparation Among Veterans

INTRODUCTION: Inadequate bowel preparation was associated with missed advanced neoplasia, lower adenoma detection rates and increased resource utilization for repeat colonoscopies. Text messaging may improve bowel preparation. ANNIE is a new VA text message service allowing for customizable educational and motivational text message reminders about clinical care. Our aim was to study the effectiveness of text messaging (via the ANNIE software) to improve the quality of colonoscopy among veterans. METHODS: We identified veterans scheduled to receive outpatient screening colonoscopies during the time period from 1/1/2019 through 3/31/2019 at the Minneapolis Veterans Affairs Medical Center (n = 640). We enrolled interested veterans to receive a series of text reminders through the ANNIE software platform regarding key steps for their bowel preparation (n = 187), in addition to usual care consisting of a nurse education phone call. Those not interested or not enrolled in ANNIE received usual care only (n = 484). Primary outcome was the total Boston Bowel Preparation (BBPS) score. Secondary outcome was patient satisfaction. RESULTS: The average age of the group was 65; 285 were diabetic, and average BMI was 31. The ANNIE group was more likely to have mental health diagnoses (If this is (Table 1). ANNIE text messaging instructions was associated with a higher BBPS score versus usual care ((8.24 versus 7.89 respectively; P = 0.002) (Figure 1). 100% of patients (n = 34) surveyed after Plan-Do-Study-Act Cycle 2 indicated that they would like to receive texts again for their next colonoscopy. CONCLUSION: ANNIE patients had higher bowel preparations scores compared to control patients, indicating that text message reminders were effective at helping patients follow bowel prep instructions. Data is likely an underestimation of the true impact of intervention as results do not account for patients turned away on day of procedure or aborted procedures. Future study will include measures of clinical significance (i.e. adenoma detection rate).

187 Poor Bowel Prep Leads to Low Yield for Inpatient Colonoscopies and Significantly Increases Overall Healthcare Cost: It Is High Time to Reevaluate Bowel Prep Options

INTRODUCTION: There have been multiple studies reporting inadequate bowel preparation based on standardized scales like Boston bowel preparation scale (BBPS) for inpatients compared to outpatient colonoscopies. Most of these inpatient procedures might be incomplete or inadequate due to bowel prep and they might be repeated the next day putting additional burden on both the patient and hospital financial system or repeated as outpatient. Aim of this study to evaluate retrospectively the efficacy of bowel prep on inpatient colonoscopy and indirectly assess healthcare delivery cost at our institution. METHODS: Prospectively collected data for all inpatient colonoscopies done at our center between January 2018 to August 2018 was retrospectively evaluated. All patient's scheduled for inpatient colonoscopy was given split dose bowel preparation according to standard guidelines. Our database included daily endoscopy and floor nurse documentation regarding completeness of bowel prep, procedure cancellation or rescheduling related to poor bowel prep and colonoscopy procedure detail including Boston Bowel Prep Score for each completed procedure. Adequate bowel preparation is consider composite BBPS 7 or above and BBPS 6 or less was considered inadequate bowel prep. RESULTS: A total of 246 (n = 246) patients were scheduled for inpatient colonoscopy from January 2018 to August 2018. Of the total patients about 136 (55.5%) patients were male and 110 (44.5%) patients were female with average age of 60.6 ± 16.15 years (Range 18–91 years). Of the total number of patients (200) who completed their procedures, a total of 114 (57.0%) patients had a total score (BBPS Right + BBPS Transverse + BBPS Left) of 7 and above and the rest 86 (43%) patients had a BBPS score of less than 7. For all these patients, a repeat colonoscopy at short interval (within 6 months–1 year) was recommended. Average cost of additional inpatient hospitalization day at our institution is at least 600$. Indirect cost with loss of overall productivity was estimated to be additional 1000$. This each inpatient colonoscopy with poor bowel prep added at least 1600$ in direct and indirect healthcare cost, not counting indirect cost incurred by patient and family members related to loss of productivity. CONCLUSION: While colonoscopy remains valuable diagnostic and therapeutic tool, current bowel prep options for inpatient colonoscopy are not sufficient. Alternative means of bowel prep options needs to evaluated in inpatient setting.

2830 Bowel Preparation Quality in a Multiethnic Population in a Safety Net Hospital

INTRODUCTION: Colonoscopy is the only colorectal cancer screening modality that permits direct visualization of the entire colon and removal of polyps. Low-quality bowel preparation has been associated with lower adenoma detection rates, increased procedure time, and increased hospital cost. An inadequate preparation limits the diagnostic accuracy and overall efficacy of colonoscopy. Factors that contribute to inadequate bowel preparations include age, male sex, inpatient status, low socioeconomic status, low English proficiency, obesity, diabetes, and cirrhosis. We investigated the complex relationship between socioeconomic factors and medical comorbidities on the quality of inpatient colonoscopy preparation. METHODS: We conducted a retrospective chart review of inpatient colonoscopies between October 2017 and April 2019. All patients received a single-dose preparation of polyethylene glycol. We collected data including demographics, medical history, indication, and bowel preparation. A Boston Bowel Preparation Score of 6 or above or an Aronchick score of “good” or “excellent” was used to define an adequate preparation. RESULTS: A total of 230 patients were included in the final analysis (Table 1). An inadequate bowel preparation was reported in 16.1% of our inpatient colonoscopies. Within the inadequate preparation group, a greater percentage of patients were male (17.3% vs. 12.3%), had low English proficiency (18.3% vs.15.3%), were not diabetic (17.7% vs.12.3%), and did not have prior bowel surgery (16.4% vs. 0.0%). Within the age, race/ethnicity, and insurance subgroups, patients who were age 80+ (21.4%), Asian-American (25%), unreported race/ethnicity (29.4%), uninsured (25%), and prisoners (22.8%) had a greater percentage of inadequate preparation (Table 2). A logistic regression was performed to assess the effects of age, sex, race/ethnicity, insurance, English fluency, diabetes, restricted mobility, and prior surgery on bowel preparation. The logistic regression model was not statistically significant. CONCLUSION: No significant socioeconomic or medical predictors of bowel preparation were found in this inpatient population which is in contrast to prior literature. While less than 20% of our patient population had inadequate bowel preparation, this is still significant in the broader context of quality, safety, and healthcare costs. Identifying strategies to increase the quality of bowel preparation still remains at the forefront of our field.

Internet-Based Patient Education Prior to Colonoscopy: Prospective, Observational Study of a Single Center's Implementation, with Objective Assessment of Bowel Preparation Quality and Patient Satisfaction.

BackgroundNonpharmacologic factors, including patient education, affect bowel preparation for colonoscopy. Optimal cleansing increases quality and reduces repeat procedures. This study prospectively analyzes use of an individualized online patient education module in place of traditional patient education.AimsTo determine the effectiveness of online education for patients, measured by the proportion achieving sufficient bowel preparation. Secondary measures include assessment of patient satisfaction.MethodsProspective, single-center, observational study. Adults aged 19 years and over, with an e-mail account, scheduled for nonurgent colonoscopy, with English proficiency (or someone who could translate for them) were recruited. Demographics and objective bowel preparation quality were collected. Patient satisfaction was assessed via survey to assess clarity and usefulness of the module.ResultsNine hundred consecutive patients completed the study. 84.6% of patients achieved adequate bowel preparation as measured by Boston bowel preparation score ≥ 6 and 90.1% scored adequately using Ottawa bowel preparation score ≤7. 94.2% and 92.1% of patients rated the web-education module as ‘very useful’ and ‘very clear’, respectively (≥8/10 on respective scales).ConclusionsOur analysis suggests that internet-based patient education prior to colonoscopy is a viable option and achieves adequate bowel preparation. Preparation quality is comparable to previously published trials. Included patients found the process clear and useful. Pragmatic benefits of a web-based protocol such as time and cost savings were not formally assessed but may contribute to greater satisfaction for endoscopists and patients.

An Intraprocedural Endoscopic Cleansing Device for Achieving Adequate Colon Preparation in Poorly Prepped Patients.

An effective bowel preparation is essential for quality colonoscopy. Inadequate preparation results in missed lesions, need for earlier repeat procedures, prolonged colonoscopy duration, an increased likelihood of adverse events, reduced patient satisfaction, and increased costs. The MOTUS GI Pure-Vu System (Tirat Carmel, Israel) is an Food and Drug Administration-cleared device designed to improve visualization in an inadequately prepared colon by facilitating intraprocedural cleaning. We evaluated the efficacy, safety, and usability of the Pure-Vu System in cleansing poorly prepared colons in human subjects. In total, 50 patients with poorly prepared colons undergoing colonoscopy were prospectively enrolled to evaluate the Pure-Vu System at 2 clinical sites [Spain (N=41) and Israel (N=9)]. Cleansing quality was measured using the Boston Bowel Preparation Score (BBPS). In total, 50 patients (64% male individuals), mean age 51.9±10.4 years, and mean body mass index of 26.6±3.1 were enrolled. The Pure-Vu System significantly increased the BBPS median score from 5.0 at baseline to 9.0 after the use of Pure-Vu (P<0.0001). Patients with an adequate cleansing level (BBPS≥2 in each colon segment) increased significantly from 31% (15/49) at baseline to 98% (48/49) after use of Pure-Vu (P<0.001). Cecal intubation was achieved in 48/49 (98%) patients. Colonoscopists were satisfied with the Pure-Vu System. No serious adverse events were reported. The Pure-Vu System was found to be safe, efficacious, and easy to use in cleansing inadequately prepared colons, enabling the colonoscopist to conduct a complete examination.

Educational virtual reality videos in improving bowel preparation quality and satisfaction of outpatients undergoing colonoscopy: protocol of a randomised controlled trial

IntroductionColonoscopy is the reference method in screening and diagnosis of colorectal neoplasm, but its efficacy is closely related to the quality of bowel preparation. Poor patient compliance is a major...

Oral Sulfate Solution versus Polyethylene Glycol as a Single-Day Preparation for Colonoscopy: A Randomized Control Trial

Abstract Background Colonoscopy is a principal diagnostic tool for most colonic disorders. Adequate bowel preparation is essential for proper visualization of the mucosa. The aim of this study was to compare the tolerability, efficacy, and safety profile of 1 L of oral sulfate solution (OSS) in comparison to 2 L of polyethylene glycol (PEG) solution. Methods In this single-center prospective study conducted at our institute, patients were randomly assigned to receive either OSS or PEG solutions for colonoscopy preparation. Patients enrolled in either group completed a questionnaire assessing the taste of the solution used, adverse effects, and number of stools passed. Grading of the bowel cleansing quality was done as per Boston Bowel Preparation (BBP) score. Results Total of 400 patients, with 222 patients in the PEG group and 178 patients in the OSS group, were assessed. In the PEG group, 148 (66.75%) patients were males and in the OSS group 112 (62.9%) patients were males. There was no statistical significance on comparison of the taste as “good” or “bad” in both groups. All the adverse events were mild to moderate in intensity and their frequencies were comparable for both the groups. The OSS group had better bowel preparation as per the BBP score (p = 0.021) and lesser cecal intubation time (p = 0.028). Conclusion The present study demonstrated that 1 L of OSS is better than the well-established 2 L PEG solution, in terms of bowel preparation and shorter time to cecal intubation.

Standardizing Inpatient Bowel Preparation Orders Improves Colonoscopy Outcomes and Reduces Provider Frustration

The quality of bowel preparation for inpatient colonoscopies is frequently poor. Many factors may account for this, including system-level issues such as varying and non-standardized methods of prep administration by covering providers. Quality improvement (QI) interventions focused on regimenting this process might impact both inpatient bowel prep quality and related healthcare outcomes. Therefore, we utilized Six Sigma principles in order to characterize the problem of inadequate inpatient preps, reduce resource utilization, and improve provider satisfaction. Formal Define, Measure, Analyze, Improve, Control (DMAIC) methodology was employed. A process map was created to define the problem through stakeholder interviews and process observation (Figure 1). A root-cause analysis was performed to identify factors contributing to poor inpatient bowel preps, which included frequent variability in ordering practices, patient intolerance, and limited guidance for assessing pre-procedure prep quality that led to missed opportunities for obtaining optimal colon preparation. These findings motivated the creation of a standardized electronic health record (EHR)-based orderset. Baseline and post-intervention data were collected as a run chart from February 2017 through June 2018, including patient demographics, procedure indication and timing relative to presentation, Boston Bowel Preparation Score (BPPS), and prep quality impact on diagnostic yield. To evaluate the knowledge, attitudes, and ease of preparing patients for colonoscopy, a survey was distributed to ordering internal medicine residents before and after the intervention. A total of 264 inpatient colonoscopies were evaluated, including 198 procedures pre- and 66 post-intervention. The proportion of procedures in which the prep quality interfered with making a diagnosis dropped from 10% to 6% (Figure 2). However, the intervention demonstrated no significant effect on the median BPPS or the number of cases delayed due to prep quality. After the intervention, providers reporting any instances of incorrect prep instructions decreased from 33% to 28%, and any frustration with the ordering process decreased from 77% to 39%. Our QI intervention reduced the number of cases in which the prep quality affected the ability to make a diagnosis. We did not achieve significant improvement in overall prep quality or reduce procedural delays, likely due to the low incidence of these outcomes at baseline. Nonetheless, our low cost and standardized colonoscopy prep EHR orderset provides “just-in-time” guidance that dramatically improved provider satisfaction, which may justify broader use of such tools.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Bowel Preparation for Surveillance Colonoscopy After Colorectal Resection: A New Perspective.

PurposeInadequate bowel preparation (IBP) is commonly observed during surveillance colonoscopy after colorectal resection. We investigated potential risk factors affecting bowel preparation.MethodsWe studied potential factors affecting bowel preparation quality. The Boston bowel preparation score was used to measure bowel preparation quality. Factors affecting IBP were analyzed, including age, body mass index, time elapsed between surgery and colonoscopy, and amount of bowel preparation drug consumed (conventional-volume vs. low-volume). Odds ratios were calculated for IBP.ResultsThis retrospective cohort study included 1,317 patients who underwent colorectal resection due to malignancy. Of these patients, 79% had adequate bowel preparation and 21% had IBP. In multivariate regression analysis, a surveillance colonoscopy within 1 year after surgery and age >80 were used as independent predictors of IBP. IBP rate of the low-volume group was significantly higher than that of the conventional-volume group among patients who underwent a surveillance colonoscopy within 1 year after surgery.ConclusionFor surveillance colonoscopy after colorectal resection, bowel preparation is affected by factors including colonoscopy timing after surgery and age. We recommend the use of conventional-volume 4-L polyethylene glycol solution when performing a surveillance colonoscopy, especially up to 1 year after surgery.

Study on the application of oral magnesium sulfate solution in split doses as bowel preparation for colonoscopy in elderly patients

Objective: To evaluate the efficacy and safety of oral magnesium sulfate solution in split doses as bowel preparation in elderly patients undergoing colonoscopy. Methods: A total of 368 elderly patients undergoing colonoscopy were enrolled at PLA General Hospital. The patients were randomly divided into magnesium sulfate solution orally in split doses group (group A, n=178) and single dose group (group B, n=190). Parameters including general information, defecation frequency, Boston bowel preparation score (BBPS), detection rate of lesions and adverse reactions. Results: The frequency of defecations in group A was (7.6±1.4), more than that in group B (6.6±1.5) with statistical significance (P<0.05). The duration of bowel preparation in group A was (128.6±25.3) min, shorter than that of group B (165.4±29.7) min (P<0.05). The BBPS in group A was (8.09±0.67), better than that of group B (7.34±0.58) (P<0.05). The detection rates of intestinal polyps and micropolyps (diameter<0.5 cm) in group A were 73/178 (41.0%) and 51/178 (28.7%) respectively, compared with 58/190 (30.5%) and 37/190 (19.5%) in group B (both P<0.05). In group A, 8 patients reported adverse reactions as abdominal distension and discomfort. One patient had ST-T abnormality of electrocardiogram (ECG). No nausea or vomiting occurred, yet 2 cases needed enema for inadequate bowel preparation. Twenty-one cases in group B reported adverse events including 7 with nausea and vomiting. There were 13 patients treated with enema. Abnormal ECG was found in 4 patients in group B. The satisfaction rate of group A was 97.8%, higher than that of group B (91.6%) (P<0.05). Conclusions: The effect of bowel preparation of elderly patients with magnesium sulfate solution in split dose has a better tolerance, good cleaning effect and low incidence of adverse reactions. It is an ideal choice for the elderly to prepare colonoscopy.

Use of smartphone applications to improve quality of bowel preparation for colonoscopy: a systematic review and meta-analysis.

Abstract Introduction Smartphone-based applications (apps) have been used to improve the quality of bowel preparation (prep) but the success rates have been variable. We have performed a systematic review and meta-analysis to evaluate the impact of smartphone apps on bowel preparation. Methods Electronic databases (MEDLINE, Embase, CINAHL and Cochrane) were reviewed for eligible studies of smartphone apps versus standard education before colonoscopy. The following outcomes were analyzed: pooled rate of adequacy of bowel prep among both arms and Boston bowel preparation score (BBPS) when reported. Pooled analysis was reported as odds ratio (OR) or mean difference in random effect model with Review Manager 5.3 (P ≤ 0.05 for statistical significance). Results Six studies were eligible with smartphone app (810 patients) vs. standard education (855 patients, control group) for bowel prep. The smartphone app group had a higher proportion of adequate bowel prep compared to the control group: 87.5 % vs 77.5 % (five studies), pooled OR 2.67; 95 %CI 1.00 – 7.13 with P = 0.05. There was substantial heterogeneity in studies with I 2 = 78 %. When analysis was limited to randomized controlled trials (RCTs), smartphone app users had a numerically higher rate of bowel cleansing: 87.1 % vs 76.9 %; however, pooled OR was not statistically significant (OR 2.66, 95 %CI 0.92 – 7.69, P = 0.07). When studies using BBPS were evaluated (n = 3), smartphone app users had higher mean scores (better bowel prep) with a mean difference of 0.9 (95 %CI 0.5 – 1.3), which was statistically significant (P &lt; 0.01). Conclusion The smartphone app is a novel educational tool that can assist in achieving adequate and better bowel cleansing before colonoscopy.

Bowel Cleansing Agents in Clinical Practice: A Cross-Sectional Study on Safety, Efficacy, and Predictor of Good Bowel Preparation

ABSTRACT Background: A good bowel preparation for colonoscopy is the most important factor that has an impact on visualization and outcome of the procedure. Aim: The primary aim of the study was to assess the quality of bowel preparation as reported by the Boston Bowel Preparation Score (BBPS). The secondary aim of the study was to analyze the patient feedback on ease of administration, palatability, and side effects with the bowel preparation. Materials and Methods: Patients undergoing colonoscopy between March 2018 and September 2018 were enrolled in the study. Patients &lt;18 years of age, those with the previous history of colorectal surgery, emergency procedures in an unprepared colon, and those not willing to participate were excluded from the study. Colon preparation of the patient was decided by senior consultants. A predesigned pro forma that included demography, indication for the procedure, preparation details, dietary recommendations the previous day if any, side effects, and patient’s comfort to preparation was completed by two-independent observers. The BBPS was used to assess the bowel preparation. A score of &lt;5 was deemed inadequate. P &lt; 0.05 was considered statistically significant. Results: The study cohort consisted of 141 patients, of which 78 were male (55.3%). Eighty (56.7%) patients received oral sulfate-based preparation and 61(43.4%) polyethylene glycol-based preparation. Nearly one third of cases reported the solution to be non palatable. 15.4% respondents reported nausea, vomiting and bloating as the major side effects of the preparation. The median duration of colonoscopy was 25 min (8–45 min). One hundred and eighteen patients (83.6%) had a BBPS score of ≥5. Sulfate preparation resulted in better bowel cleansing (P = 0.01). Age, gender, and dosing schedule of preparation, including bedtime dosing of stimulant laxative, did not alter the BBPS score. Conclusion: Sulfate- and polyethylene glycol-based preparations are commonly used for cleansing the colon. Bowel cleansing was adequate in most patients and sulfate-based yielded better bowel cleansing. Nearly 15.4% of patients reported side effects to these preparations.

Peppermint Oil to Improve Visualization in Screening Colonoscopy: A Randomized Controlled Clinical Trial

BackgroundScreening colonoscopy has been associated with reduced mortality from colorectal cancer by means of early detection and timely treatment. However, visualization during colonoscopy is often impaired since the colon is naturally prone to peristalsis and spasm. There is evidence to suggest benefit of topical peppermint oil in causing smooth muscle relaxation, thereby decreasing peristalsis. The aim of our study was to determine if peppermint oil helps reduce colonic spasticity so as to allow for better visualization during screening colonoscopy.MethodsWe performed a randomized controlled, double-blinded, clinical trial where patients undergoing screening colonoscopy were assigned to receive either peppermint oil or placebo. Once cecum was reached, 50 mL of either solution was directly injected via the working channel of the colonoscope. Colonic peristalsis, spasticity and bowel visibility were documented. Bowel preparation quality, withdrawal time and adenoma detection rate (ADR) were also assessed. Continuous variables were analyzed using t-test or Wilcoxon rank-sum test while categorical variables were compared using the two-way Chi-square test.ResultsForty-eight patients were included, of whom 24 patients received peppermint oil and 24 received placebo. Mean Boston bowel preparation score (BBPS) was excellent for both groups (8 points vs. 7.9 points; P = 0.98). Both mean total colonoscopy time (17.8 min vs. 21.9 min; P = 0.07) and mean cecal intubation time (7.2 min vs. 10.3 min; P = 0.04) were shorter with peppermint oil as compared to placebo. Complete absence of bowel spasticity was observed among 58.3% patients in the peppermint oil group as compared to 45.8% patients in the placebo group (P = 0.05). More than 75% of bowel was visualized in 83% of patients in both groups (P = 0.56). Mean ADR was higher in the peppermint group as compared to the placebo group (45.8% vs. 37.5%; P = 0.56).ConclusionOur study suggests that topical peppermint oil reduces bowel wall spasticity, which could lead to better visualization of the bowel during screening colonoscopy. Although use of peppermint oil was associated with better ADRs, these results did not achieve statistical significance. Larger sample size and use of alternative methods of peppermint oil administration allowing for more absorption time may establish stronger results.

Favorable outcomes of prepackaged low‐residue diet on bowel preparation for colonoscopy: Endoscopist‐blinded randomized controlled trial

2L polyethylene glycol plus an ascorbic acid (PEGA) is known to be as effective. However, 2L polyethylene glycol-based regimens are often still difficult for patients to tolerate. Therefore, we conducted this study to evaluate the potential of 1L PEGA with prepackaged low-residue diet (PLD) as an alternative to 2L PEGA before colonoscopy. The subjects were randomly assigned to either of the two groups. The 2L PEGA group received 2L PEGA split regimen. The 1L PEGA with PLD group received PLD on the day preceding colonoscopy and 1L PEGA. All endoscopic procedures were performed by one physician who did not know patients allocation. Bowel preparation status were graded using Boston Bowel Preparation Score (BBPS). A questionnaire regarding tolerability and safety was administered. This trial is registered at ClinicalTrials.gov (NCT03329339). A total of 173 patients completed the study (86 in the 2L PEGA group and 87 in the 1L PEGA with PLD group). Bowel preparation was adequate in 88.4% (76/86) of patients in the 2L PEGA group and 93.1% of patients in the 1L PEGA with PLD group (81/87, P=0.28). The patients in the 1L PEGA with PLD group had higher whole Boston Bowel Preparation Scale score (P=0.02) and expressed more satisfaction and willingness to repeat the procedure (P<0.01). There was no significant difference with respect to compliance or safety. 1L PEGA with PLD showed equivalent efficacy, greater satisfaction, and more willingness to repeat compared with 2L PEGA for bowel preparation.

Use of Simethicone After Capsule Ingestion and Its Impact on Quality of Small Bowel Video Capsule Endoscopy: A Pilot Study

2891 Figure 1. Shows comparison in means of variance with 95% confidence interval in SBVQ at proximal, middle, distal and cumulative small bowel within three research arms: control, sham and treatment.Introduction: Small bowel capsule endoscopy is a tool to visualize the small bowel (SB) for things like obscure bleeding. Studies suggest that using Polyethylene glycol (PEG) prep is significantly better compared to clear liquid and overnight fast in terms of small bowel visualization quality (SBVQ). No studies have been done where simethicone is ingested after capsule swallowing.We intend to give patients simethicone 1 hour after capsule ingestion for two consecutive hours and compare results for SBVQ pre-and post-ingestion groups. We hypothesize post capsule simethicone ingestion group will have significant improvement in SBVQ. Methods: Patient in outpatient setting were divided in control, sham and treatment group. Control group followed the standard hospital pre-capsule protocol that included PEG 238 gram the evening prior. Sham included group that received 3ml of simethicone (20mg/0.3ml) 20 minutes prior to swallowing of the capsule. Treatment group contained patients that had simethicone 3ml 20 minutes prior to capsule swallowing and then 3ml after 1 hours and then 1.5 ml after another 1 hour totaling 7.5ml simethicone. Data concerning SBVQ for every patient was evaluated as an individual zone score from 1-3 points, each in proximal, middle and distal SB and then get a cumulative number 1-9 after adding the three zones together. These points were derived using the Boston bowel prep score. Results: We had 5 patients in control, 4 in sham and 6 in treatment group. Proximal SB: The sham group had a statistically significant higher SBVQ compared to control. The SBVQ of treatment group was higher than control though wasn't statistically significant. Middle SB: No difference was seen in SBVQ. Distal SB: SBVQ mean dropped in treatment group but there wasn't any statistically different. Cumulative SB: Score from all three group zones when added together showed no difference in SBVQ between the three research arms (figure 1). Conclusion: There was no statistically significant difference in the SBVQ when looking at the cumulative score of the entire small bowel. However, there was statistically significant improvement in SBVQ at the proximal segment of SB between sham and the control group suggesting simethicone may be helpful in increasing visualization early on in the SB and not so much as capsule reaches more distally. This is only a pilot project and results may vary when the power of our study increases.

Total Underwater Colonoscopy versus Standard CO2 for Adenoma Detection: A Randomized Controlled Tandem Colonoscopy Trial: Category Award (General Endoscopy)

Introduction: Although water exchange may improve adenoma detection when compared to CO2, it is unclear whether water is a better medium for insufflating the lumen and inspecting the mucosa. Total underwater colonoscopy (TUC) involves the use of water exchange with the air valve shut off during insertion, followed by the performance of the exam, including inspection of the mucosa and polypectomy under water. Our goal was to compare TUC to standard CO2 using a randomized tandem colonoscopy design. NCT03231917 Methods: We randomized participants to have tandem colonoscopies using TUC or CO21st to insufflate the colon and inspect the mucosa for adenomas, followed by a 2nd exam with the other method.. The primary endpoints were polyp and adenoma miss rates for the first exam, calculated as the number of additional polyps detected during the 2nd exam divided by the total number of polyps detected by both exams. Inspection times were calculated by subtracting time for polypectomy, and care was taken to keep the times equal for both exams. Co-variates included participant age and sex, indication, personal history of neoplasia, family history of CRC, time (insertion, inspection, withdrawal and total), volume of water infused during insertion and withdrawal, Boston Bowel Prep Score, and sedation. All results are polyp level analyses. Results: Based on sample size calculations, 121 participants were randomized (61 having CO21st and 60 TUC 1st)(Endoscopist 1: 25 TUC 1st/26 CO2 1st; Endoscopist 2: 11 TUC 1st/ 9 CO2 1st; Endoscopist 3: 24 TUC 1st /26 CO2 1st). There were no significant differences between groups with respect to age, sex, family history, BBPS and sedation. The insertion time was longer for TUC than CO2. Characteristics for TUC versus CO2 exams are shown in Table 1. The overall polyp miss rate was significantly higher for the TUC 1st group (81/237;34%) versus the CO2 1st cohort (57/264; 22%)(p=0.002). The adenoma miss rate was also higher for the TUC first group (52/146; 36%) versus the CO2 group (37/159; 23%) (p=0.025) (Table 2). However, 1 of the 3 endoscopists had a numerically higher miss rate for CO2. After adjusting for times, participant characteristics and bowel preparation, TUC was more likely to miss polyps/ adenomas than CO2 (Table 3). Conclusion: Our findings suggest that TUC is not a superior medium to CO2 to insufflate the colon and inspect the mucosa for polyps or adenomas. However, TUC may benefit some endoscopists, an issue which requires further study.477_A Figure 1 No Caption available.477_B Figure 2 No Caption available.477_C Figure 3 No Caption available.

Longer Retroflexion Duration Significantly Improves Adenoma Detection Rate in the Right Colon: A Multicenter Prospective Pragmatic Clinical Trial

Introduction: Adenoma detection rate (ADR) is a quality measure for colonoscopies. Miss rate for adenomas can be as high as 30% and lesions on the right-side of the colon are particularly high risk of getting missed. Retroflexion has been shown to improve ADR but ideal time for retroflexion is unknown. Methods: Patients above the age of 45 (or if screening was indicated prior to that), who underwent screening colonoscopy, were included. ADRR (Adenoma detection rate in the right colon), was compared when ≥ 30 seconds (s) were spent during retroflexion in the right colon (cecum up to the hepatic flexure), with when ≥ 30s were spent during retroflexion in the right colon. Results: 275 patients were included with 182 patients (66%) were included in the < 30s group and 93 patients (34%) in the ≥ 30s group Mean age was 60 years SD ± 9.9 years. 77% patients were Caucasian and 19% were African American. 55% patients were female. Median withdrawal time was 11mins, and median right colon withdrawal time (RWT) was 3.5mins. Adult colonoscope (12.8mm) was used in 77% of patients. ADR in the right colon was 36% when retroflexion was performed for ≥ 30s compared to 20% in < 30s group, p=.006. Polypectomy time was excluded if it was done in retroflexion. Polyps that were seen only on retroflexion, which could not be seen on forward view, were significantly more likely to be found in the ≥ 30s group (19%, n =16) compared to the < 30s group 3%, p< .0001. GI fellows were successful in retroflexion in 64% vs. 76% with attending physicians p=.025. Retroflexion success was 90% without looping, vs. 34% with severe looping, p< .0001. Retroflexion was successful in 55% with Boston bowel prep score of 2 compared to 75% with score of 3 in the right colon p=.021. Patients in whom retroflexion failed had a higher BMI (mean 31.9 vs. 29.4 when retroflexion failed, p=0.01). There was no difference in success of retroflexion with sex (p=.5), ASA score (p=.07), race (p=.16), indication (.7), type of colonoscope (p=.16). Looping was identified as a reason for retroflexion failure by the endoscopist in 73% of cases, narrow lumen in 4%, poor prep in 4% and type of scope/technical issues in 20% of cases. Conclusion: Adenoma detection rate in the right colon was significantly improved when retroflexion was performed for a longer duration. Barriers to successful retroflexion included looping of the colonoscope, abdominal pressure, BMI, fellow participation and bowel prep quality.182 Figure 1 No Caption available.

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