Quality Of Colonic Preparation Research Articles

Improving Inpatient Colonoscopy Preparation in a University Hospital: An Evidence-Based Practice Project.

The majority of inpatient colonoscopy preparations at Virginia Commonwealth University Medical Center were rated as suboptimal, leading to incomplete or aborted procedures. These procedures needed to be rescheduled and delayed the patient's discharge from the hospital. An evidence-based practice model was used to implement an electronic colonoscopy order set. This resulted in improved quality of colon preparation and reduced canceled procedures. The potential savings for the hospital attributed to improvements in the bowel preparation processes for inpatient colonoscopies were calculated to be $418,200.00 annually.

Prevalence of Advanced Colorectal Adenomas in Patients Undergoing Screening Colonoscopy in a Safety-net Hospital

Introduction: Advanced colorectal adenomas are important precancerous lesions and include adenomas>9mm in size, tubulovillous histology, and high grade dysplasia. The aim of this study is to measure the prevalence of adenomas and advanced adenomas in patients undergoing screening colonoscopy, and to compare the prevalence in African Americans and other racial groups. Methods: We performed a retrospective analysis of all asymptomatic patients who underwent screening colonoscopy between July 1st 2009 and June 30th 2014. Patients with history of polyps, positive FOBT, diagnostic, or incomplete/inadequate colonoscopies were excluded. Data about patients' age, race, gender, quality of colon preparation, fellow participation (none, first, second, and third year), adenoma detection, size, location and histology were analyzed. Logistic regression was used to calculate the crude and adjusted odds ratios for the association of colonic findings with African Americans compared to other racial groups. Results: A total of 7171 screening colonoscopies were performed during the study period. 6448 patients (90%) had an adequate and complete examination, 632 patients (8.8%) had an inadequate/poor colon preparation, and 48 patients (0.7%) had failed cecal intubation. Among patients with adequate and complete examination, 2326 (36%) were men and 4122 (64%) women. Mean age was 58 years. The majority of patients were African Americans (n=5691, 88.4%), followed by white (n=334, 5.2%), Hispanic (n=213, 3.3%) and Asian (n=105, 1.6%). The overall prevalence of adenomas was 32.3%, and that of advanced adenomas was 8.3%. Overall, African Americans had similar rates of advanced adenomas compared to other racial groups (adjusted OR 1.15, 95% CI 0.9-1.5). There was a higher rate of high grade dysplasia/ cancer in African Americans compared with other racial groups (1.4% Vs. 0.5%, adjusted OR 2.9, 95% CI 1.1-8). Rates of nonadvanced adenomas, adenomas>9mm, and adenomas with tubulovillous histology were similar among both groups (table 1). The distribution of adenomas in the proximal and distal colon was similar in both groups. Conclusion: The overall prevalence of advanced adenomas was similar between African Americans and other racial groups. However, the prevalence of adenomas with dysplasia/cancer was significantly higher in African Americans. This supports the need for special efforts to improve colorectal cancer screening participation rates in African Americans.Table 1: Prevalence of advanced adenomas among African Americans and other racial groups

Comparison of Adenoma Detection Rate (ADR) in Split-Dose Versus Same-Day Colonoscopy Preparation: A Systemic Review and Meta-analysis

Introduction: Preparation to colonoscopy (PC) interval has been recently shown to have important impact on colposcopy preparation. A few studies have shown that same day colon preparation is superior to split dose preparation with less adverse effects, better quality of life and superior Ottawa scale scores for quality of colon preparation. However, none of the studies used adenoma detection rate, a bench mark of adequate colonoscopy, as a primary outcome. Some studies have shown superior detection rate in same day preparation whereas others suggest no difference. Our aim was to conduct meta-analysis to see which approach has higher adenoma detection rate and to determine pooled effect size if one or the other approach is better. Methods: We searched Medline, EMBASE, Cochrane database, ISI Web of Science and Scopus from inception through May 2015, to identify prospective and randomized control studies that provided data on adenoma detection rate using morning only compared with split dose preparations for afternoon colonoscopies. After pooling data, a fixed effects meta-analys was performed as there was no significant heterogeneity in study population. Three out of 157 studies were considered in analysis. All included studies reported adenoma detection rate (ADR) as one of the secondary outcomes. Results: Two prospective and one randomized clinical trials were included in the analysis which consisted of a total of 477 patients. The study populations in all three studies were well matched for baseline characteristics. The pooled odds ratio (OR) evaluating the adenoma detection in split dose cohort compared to same day group was 0.68 (95% confidence interval (CI) 0.46 - 1.01. No significant heterogeneity (I2=0) or publication bias were noted. Conclusion: Pooled analysis failed to show statistically significant difference in adenoma detection rate (ADR) between same day or split dose preparations. However, a trend towards higher adenoma detection rate in same day preparation cohort was noted. Our analysis has limitations due to lack of large randomized trials and the fact that half of the pooled effect was contributed by one study. In addition adenoma detection rate was not used as primary outcome in any of the studies published to date. This highlights the need for further trials using ADR as primary outcome before same day preparation can become a standard of care.Figure 1

Anaphylactic shock caused by ingestion of polyethylene glycol.

Colonoscopy is the current standard method for evaluation of the colon. The diagnostic accuracy and therapeutic safety of colonoscopy depend on the quality of colonic cleansing and preparation. Generally, all these preparations have been demonstrated to be safe for use in healthy individuals without significant comorbid conditions. Based on safety and efficacy concerns, polyethylene glycol (PEG) is most commonly utilized as a bowel preparation solution for colonoscopy. Adverse events in patients receiving PEG are mostly clinically non-significant. However, fatal adverse events rarely have been shown to occur in the few individuals who experience vomiting or aspiration. Anaphylactic shock associated with ingestion of PEG electrolyte solution is an extremely rare fatal complication, and reported mainly in Western countries. Here, we report the first case of anaphylactic shock following the ingestion of PEG solution in Korea.

Impact of fair bowel preparation quality on adenoma and serrated polyp detection: data from the New Hampshire Colonoscopy Registry by using a standardized preparation-quality rating

The effect of colon preparation quality on adenoma detection rates (ADRs) is unclear, partly because of lack of uniform colon preparation ratings in prior studies. The New Hampshire Colonoscopy Registry collects detailed data from colonoscopies statewide, by using a uniform preparation quality scale after the endoscopist has cleaned the mucosa. To compare the overall and proximal ADR and serrated polyp detection rates (SDR) in colonoscopies with differing levels of colon preparation quality. Cross-sectional. New Hampshire statewide registry. Patients undergoing colonoscopy. We examined colon preparation quality for 13,022 colonoscopies, graded by using specific descriptions provided to endoscopists. ADR and SDR are the number of colonoscopies with at least 1 adenoma or serrated polyp (excluding those in the rectum and/or sigmoid colon) detected divided by the total number of colonoscopies, for the preparation categories: optimal (excellent and/or good), fair, and poor. Overall/proximal ADR/SDR. The overall detection rates in examinations with fair colon preparation quality (SDR 8.9%; 95% confidence interval [CI], 7.4-10.7, ADR 27.1%; 95% CI, 24.6-30.0) were similar to rates observed in colonoscopies with optimal preparation quality (SDR 8.8%; 95% CI, 8.3-9.4, ADR 26.3%; 95% CI, 25.6-27.2). This finding also was observed for rates in the proximal colon. A logistic regression model (including withdrawal time) found that proximal ADR was statistically lower in the poor preparation category (odds ratio 0.45; 95% CI, 0.24-0.84; P< .01) than in adequately prepared colons. Homogeneous population. In our sample, there was no significant difference in overall or proximal ADR or SDR between colonoscopies with fair versus optimal colon preparation quality. Poor colon preparation quality may reduce the proximal ADR.

Efficacy and tolerability of low‐volume (2 L) versus single‐ (4 L) versus split‐dose (2 L + 2 L) polyethylene glycol bowel preparation for colonoscopy: Randomized clinical trial

To compare the efficacy and tolerability of a low-volume (2-L) polyethylene glycol (PEG) regimen for colonoscopy compared to single (4-L) or split-dose (2-L + 2-L) regimens. In-hospital patients who were candidates for colonoscopy were randomly assigned to: group 1 single-dose (PEG 4 L the day before the study, n = 60); group 2: split-dose (2 L the day before and 2 L on the day of the procedure, n = 61); and group 3: low-volume 2-L PEG solution (the day of the procedure, n = 59). A blinded evaluation of the quality of colonic preparation was assessed by the Boston bowel preparation scale. Satisfactory bowel preparation of the right colon was more frequently reported for group 3 than for group 1 (70% vs 53%, P = 0.045), in the transverse colon it was 82% versus 69% (P = 0.032), and on the left side of the colon it was 80% versus 67.7% (P = 0.028). Compared to group 2, satisfactory bowel preparation in group 3 was similar in the transverse colon and left colon. Nausea, vomiting, and abdominal discomfort were less frequent in patients of group 3. Patients in group 3 had fewer sleep disorders and fewer hours of sleep loss compared to patients in the other groups. Preparation with 2 L caused less abdominal discomfort and fewer sleep disorders. The split dose had a better quality of preparation in the right colon. Both preparations were clearly better than the 4-L preparation.

The inulin hydrogen breath test predicts the quality of colonic preparation

Successful bowel preparation is essential to an adequate performance of colonoscopy. Polyethylene glycol (PEG) with electrolyte solutions induces diarrhea with depletion of substrates fermentable by hydrogen (H2)-producing colonic microbiota. Inulin has recently been suggested as a prebiotic substrate for the H2 breath test because it is resistant to intestinal hydrolysis and is fermented mostly by the colonic bacteria. This study aimed to assess time-dependent changes in H2 breath levels in order to predict the colonic preparation of patients scheduled for colonoscopy with or without oral supplementation of inulin. In this prospective nonrandomized trial, 127 subjects drank 4 l of PEG 280-mg solution as bowel preparation for colonoscopy. A subgroup of 31 patients also ingested inulin (10 g in 200 ml of water) at breakfast as an additional substrate to increase colonic H2 production. Measurements of H2 breath levels were performed immediately before and after colonic preparation. As the main outcome measure, the quality of the colonic preparation was scored as excellent to fair (i.e., clean bowel allowing successful pan-colonoscopy, including the terminal ileum) or poor (incomplete colonoscopy due to fecal debris). The H2 breath levels decreased from 11.0 ± 1.8 ppm before PEG to 1.8 ± 0.3 ppm after PEG (n = 18; P < 0.001). The H2 concentrations after PEG ingestion were significantly lower (P < 0.001) in the patients with excellent-to-fair preparation than in the 19 patients with poor preparation. Ingestion of inulin induced an overall increase in H2 breath levels and improved discrimination between the patients with excellent-to-fair colonic preparation and those with poor preparation, leading to the sensitivity and specificity of such a test reaching 100 %. The H2 breath test with inulin ingestion can be a simple, noninvasive, reliable method for predicting successful colonic preparation that leads to cost savings and less patient discomfort/stress or need to repeat colonoscopy.

Bowel preparation, the first step for a good quality colonoscopy.

Bowel preparation, the first step for a good quality colonoscopy.

The impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy

Suboptimal colon preparation is a significant barrier to quality colonoscopy. The impact of pharmacologic agents associated with gastrointestinal dysmotility on quality of colon preparation has not been well characterized. Evaluate impact of opiate pain medication and psychoactive medications on colon preparation quality in outpatients undergoing colonoscopy. Outpatients undergoing colonoscopy at a single medical centre during a 6-month period were retrospectively identified. Demographics, clinical characteristics and pharmacy records were extracted from electronic medical records. Colon preparation adequacy was evaluated using a validated composite colon preparation score. 2600 patients (57.3 ± 12.9 years, 57% female) met the inclusion and exclusion criteria. 223 (8.6%) patients were regularly using opioids, 92 antipsychotics, 83 tricyclic antidepressants and 421 non-tricyclic antidepressants. Opioid use was associated with inadequate colon preparation both with low dose (OR = 1.4, 95%CI 1.0-2.1, p = 0.05) and high dose opioid users (OR = 1.7, 95%CI 1.1-2.9, p = 0.039) in a dose dependent manner. Other significant predictors of inadequate colon preparation included use of tricyclics (OR = 1.9, 95%CI 1.1-3.0, p = 0.012), non-tricyclic antidepressants (OR = 1.5, 95%CI 1.1-2.0, p = 0.013), and antipsychotic medications (OR = 2.2, 95%CI 1.4-3.4, p = 0.001). Opiate pain medication use independently predicts inadequate quality colon preparation in a dose dependent fashion; furthermore psychoactive medications have even more prominent effects and further potentiates the negative impact of opiates with concurrent use.

Improving the Quality of Colonoscopy Bowel Preparation Using an Educational Video

Colonoscopy is the preferred modality for colon cancer screening. A successful colonoscopy requires proper bowel preparation. Adequate bowel preparation continues to remain a limiting factor. One hundred thirty-three patients scheduled for an outpatient colonoscopy were prospectively randomized in a single-blinded manner to video or nonvideo group. In addition to written bowel preparation instructions, patients in the video group viewed a brief instructional video. Quality of colon preparation was measured using the Ottawa Bowel Preparation Quality scale, while patient satisfaction with preparation was evaluated using a questionnaire. Statistical analyses were used to evaluate the impact of the instructional colonoscopy video. There were significant differences in the quality of colonoscopy preparation between the video and the nonvideo groups. Participants who watched the video had better preparation scores in the right colon (P=0.0029), mid-colon (P=0.0027), rectosigmoid (P=0.0008), fluid content (P=0.03) and aggregate score (median score 4 versus 5; P=0.0002). There was no difference between the two groups with regard to patient satisfaction. Income, education level, sex, age and family history of colon cancer had no impact on quality of colonoscopy preparation or patient satisfaction. The addition of an instructional bowel preparation video significantly improved the quality of colon preparation.

How to read and report CTC

Owing to encouraging results achieved in the clinical practice, CT colonography (CTC) is being increasingly employed for the examination of the whole colon and rectum and is quickly becoming a widely accepted diagnostic technique that is replacing double contrast barium enema and appears a promising tool for colorectal cancer screening as well. The increasing number of symptomatic and asymptomatic patients undergoing CTC for both evaluation of symptoms and colorectal cancer screening, along with the growing availability of CTC facilities in most healthcare departments and imaging centres, requires that a sufficient number of radiologists be adequately trained in performing and interpreting CTC studies. Indeed, optimal performance of CTC depends on a number of factors, including the quality of colonic preparation (e.g. laxative bowel cleansing and optimised colonic distension), the CTC image acquisition protocol used, and reading approach and specific skills of radiologists for correct detection and interpretation of colonic findings. Consequently, dedicated training and expertise is key to obtain high sensitivity in lesion detection and reduce the number of false positives, thus ensuring an optimal clinical management of patients. To this purpose, dedicated training programmes are essential to teach and standardise not only the approach to CTC reading, but also reporting of colonic findings.

Improving Quality of Colonoscopy Bowel Preparation with an Educational Video: Presidential Poster

Purpose: To evaluate the impact of a supplementary bowel preparation instructional video on the quality of colonoscopy preparation and patient satisfaction Methods: 127 patients scheduled for an outpatient colonoscopy were prospectively randomized in a single blinded manner to video or non-video group. In addition to written bowel preparation instructions, patients in the video group viewed a brief instructional video prior to starting their preparation. All patients prepped with SUPREP Bowel Prep Kit and had a morning colonoscopy. Quality of colon preparation was measured by the endoscopist using the Ottawa Bowel Preparation Quality Scale, a validated instrument requiring the endoscopist to rate cleansing in three segments (right colon, mid colon, and recto-sigmoid colon) on a scale of 0 - 4, with 0 indicating perfect cleansing, and overall fluid quantity on a scale of 0 - 2, with 0 indicating no fluid in the colon. The individual scores are summed to create a total score, with lower scores indicating better preparation. Patient satisfaction with preparation was evaluated using a questionnaire. Statistical analysis was employed to evaluate the impact of the colonoscopy video. Results: There were significant differences in the quality of colonoscopy preparation between the video and the non-video group. Participants that watched the video had superior preparation scores in the right colon (0.71 vs 1.47, p<0.001), transverse colon (0.73 vs 1.44, p<0.001), left colon (0.77 vs 1.45, p<0.001), fluid content (0.87 vs 1.22, p=0.004), and aggregate score (3.08 vs 5.58, p<0.001). Video had no impact on patient satisfaction, with about 85% of patients in both groups rating their satisfaction as a 4 or 5 (5 point scale with 5 = satisfied). The higher the patient's level of education, the lower the Ottawa score of the left colon with a correlation of -.20 (p<.05). Age was significantly related to left colon preparation with a correlation of .19 (p<.05) such that older individuals had less effective cleaning in this segment. Although older patients were more likely to find their previous colonoscopy experiences to be more satisfying (significant correlation of .44 (p<.05)), only 21% of all patients who had a prior colonoscopy found the previous experience more satisfying. Socioeconomic status, ethnicity, gender, or family history of colon cancer did not reveal any significant correlation to quality of colonoscopy preparation or patient satisfaction. Conclusion: Adequate bowel cleansing remains an important factor for providing a quality study of the colon. The addition of an instructional bowel preparation video significantly improves the quality of colon preparation. Disclosure: Sateesh R. Prakash, M.D.- research grant from Braintree Laboratories, Inc for the submitted research abstract and study. This research was supported by an industry grant from Braintree Laboratories, Inc.

Adenoma Detection Rates in an Urban Hospital with African American Majority

Purpose: The adenoma detection rate (ADR) is an important quality indicator of screening colonoscopy. Grady memorial hospital is an urban hospital that serves a large indigent population of African American majority. The aim of this study is to measure the overall adenoma detection rates, and compare ADR in black and non black patients. Methods: This is a retrospective analysis of all asymptomatic patients who underwent first-time screening colonoscopy between June 1st 2011 and June 1st 2012. Data about age, race, gender, quality of colon preparation, adenoma detection, size and histology were recorded and analyzed. Results: A total of 2,202 screening colonoscopies (1,429 women and 773 men) were performed during the study period. 2,038 patients (92.6%) had an adequate and complete examination, while 146 patients (6.6%) had an inadequate/poor colon preparation, and 18 patients (0.8%) had failed cecal intubation. Among patients with adequate and complete examination, 711 (35%) were men and 1,327 (65%) were women. Mean age was 58 years. The majority of patients were black (n=1,760 patients, 86.4%), followed by white (n=124, 6.1%), Hispanic (n=66, 3.2%), Asian (n=45, 2.6%) and other races (n=43, 2.4%). The overall ADR was 29.2% (595/2,038). The ADR was 35.3% in men and 25.9% in women. The ADR was comparable in black patients (28.6%, 503/1,760) versus non black (33.1%, 92/186); p=0.136. The prevalence of adenomas sized more than 9 mm in diameter was similar between black (107/1,760, 6.1%) and non black patients (20/278, 7.2%); p=0.5. The prevalence of adenomas with advanced histology (high grade dysplasia, villous, tubulovillous or carcinoma) was similar between black (72/1,760, 4.1%) and non black patients (10/278, 3.6%); p=0.87. The ADR increased with increasing age among all racial groups.Table: [1939] Prevalence of adenomas and advanced lesions by race and genderConclusion: Cecal intubation rates and ADR compared favorably to accepted quality standards. Contrary to previous reports, the prevalence of adenomas, adenomas >9 mm in size, and adenomas with advanced histology was similar in black and non black patients.

Prevalence of Adenomas during Screening Colonoscopy Using a Comprehensive Colonoscopy Screening Protocol

Purpose: Background and Aim: The adenoma detection rate is an independent predictor of the risk of interval colorectal cancer after screening colonoscopy. A number of techniques have been shown to maximize adenoma detection. We incorporated a comprehensive colonoscopy screening protocol that includes: 1. Ensuring a clean quality of colon preparation; 2. Cecal intubation in over 95%; 3. Colonoscope withdrawal time > 6 min; 4. Colonoscopy Screening Techniques for better adenoma detection (a. Use of a cap fitted endoscope to examine behind the folds; b. Patient position change to optimize distention of the colon; c. Eyes trained to detect flat lesions after looking at several flat lesions' images & videos). We have reported the effect of combining all these various techniques to maximize adenoma detection rate in 100 consecutive average risk patients (pts) undergoing screening colonoscopy previously. We report the adenoma detection rate in larger pool of 535 consecutive patients undergoing their first screening colonoscopy from 2009-2011. Methods: Endoscopist: Screening colonoscopy was performed by a single operator. Patients (pts): 535 consecutive patients undergoing screening colonoscopy from 2009-2011 were included in the study. Average risk pts: 495. Increased risk pts (Family history of colorectal cancer or polyps <60 years): 40. We used the comprehensive colonoscopy screening protocol to maximize adenoma detection in all patients during screening. Colonoscopy Report: The data was recorded in a structured colonoscopy report with well-defined fields to capture all the data. Main Outcome Measurements: We analyzed the adenoma detection rates. Results: Mean age: 58.3 ± 7.7; Sex: Men: Women: 220:315; BMI: 27.4 ± 5.4. Caucasians: 395(73.8%).The adenoma detection rate in screening population: 64.9%. The advanced adenoma detection rate (>1 cm adenoma or villous histology of any size or high grade dysplasia):14%.The multiple adenoma (≥ 3 adenomas) detection rate: 17%. The combined adenoma or proximal hyperplastic polyp detection rate: 69.7%. The proximal hyperplastic polyp detection rate: 15.3%. The serrated adenoma detection rate: 15%. The proximal hyperplastic polyp or serrated adenoma detection rate: 26.7%. See Table 1.Table: [1974] Prevalence of adenomas in 535 consecutive patients undergoing screening colonoscopies using a comprehensive colonoscopy screening protocolConclusion: Routine use of techniques to maximize adenoma detection result in persistent increase in adenoma detection rates, several fold higher than the adenoma detection rate set by the U.S Multi-Society Task Force on Colorectal Cancer (25% in men & 15% in women).

A randomized controlled trial of sodium phosphate tablets and polyethylene glycol solution for polyp detection

The study was aimed to assess the efficacy of sodium phosphate (NaP) tablets and polyethylene glycol (PEG) on colon cleansing. A prospective, randomized trial was conducted at the Graduate School of Medicine, University of Tokyo. Participants who were scheduled for colonoscopy were included and randomized into either the NaP or PEG group. An interim analysis was programmed into the study design when approximately 50% of the enrolments were completed. The primary outcome was the detection rate of polyps with a diameter ≤5 mm. A total of 92 patients were included in the analysis, of whom 44 were in the NaP group and 48 in the PEG group. The quality of colonic preparation was similar in both groups. The NaP group showed a higher detection rate of polyps with a diameter ≤5 mm than the PEG group (38.6% vs 18.8%, P = 0.004). A multivariate analysis showed that NaP and the withdrawal time of the colonoscope were independent factors associated with the detection of polyps with a diameter ≤5 mm. NaP is certainly not inferior to PEG. In fact, the results suggest that diminutive polyp detection using NaP might be superior to that using PEG.

Su1288 High Synchronous Polyp Burden in Patients With ≥ 1 CM Colon Polyps

Colonoscopy screening techniques have evolved over the last decade. Techniques shown to maximize adenoma detection include: 1. Clean quality of colon preparation; 2. Cecal intubation; 3. Colonoscope withdrawal time > 6 min; 4. Colonoscopy Screening Techniques for better adenoma detection (a. Use of a cap fitted endoscope to examine behind the folds; b. Patient position change to optimize distention of the colon; c. Eyes trained to detect flat lesions after looking at several flat lesions' images & videos).

Impact of previous gastric or colonic resection on polyethylene glycol bowel preparation for colonoscopy

Adequate bowel preparation is essential for successful completion of colonoscopy. This study examines whether previous bowel resection affects the quality of bowel preparation. This study prospectively included patients who had gastric or colonic resection (bowel resection group, n = 92) and a control group (n = 92). All patients received 4 L polyethylene glycol (PEG) for bowel preparation. Quality of colonic preparation was assessed using the Aronchick scale (excellent, good, fair, or poor) and was categorized as satisfactory (excellent or good) or unsatisfactory (fair or poor). We analyzed whether previous gastric or colonic resection is associated with unsatisfactory preparation. Bowel preparation quality was significantly different between the resection group (0, 39.1, 43.5, and 17.4%, for excellent, good, fair, and poor) and control group (3.3, 53.3, 38.0, and 5.5% for excellent, good, fair, and poor, P = 0.011). Inadequate bowel preparation was significantly higher in the resection group than in the control group (60.9% vs. 43.5%, P = 0.018). Univariate analysis revealed height, weight, body mass index, and bowel resection to be predictors of unsatisfactory preparation. Multivariate analysis revealed bowel resection [odds ratio (OR) 2.12; 95% confidence interval (CI): 1.16-3.86] and obesity (body mass index ≥ 25 kg/m(2)) (OR 2.16; 95% CI: 1.13-4.12) to be independent predictors of unsatisfactory preparation. The prevalence of unsatisfactory and poor bowel preparation quality was 79.3 and 37.9% in obese patients with previous bowel resection. Previous bowel resection was an independent predictor of unsatisfactory PEG bowel preparation. More attention is needed for patients with previous bowel resection, especially for obese patients.

The Impact of the Quality of Colon Preparation on Follow-Up Colonoscopy Recommendations

Published guidelines for timing of follow-up colonoscopy assume that the entire colon mucosa is visualized and provide no guidance in the case of poor preparations. We aimed to determine how preparation quality during screening colonoscopy affects gastroenterologists' recommendations on the timing of follow-up colonoscopy. Gastroenterologists were shown representative images of four colonoscopies with differing colon-preparation quality. For each set of images they were asked to recommend when a hypothetical patient with no polyps or malignancy on screening examination should return for a subsequent colonoscopy. For the same patient, gastroenterologists were asked to give recommendations based on a preparation-quality grading scale. The survey was completed by 239 gastroenterologists. Nearly all recommended 10-year follow-up colonoscopy for the best-appearing preparation. For the three imperfect preparations there was considerable variability in recommendations; follow-up timing ranged from 1-2 days to 10 years for identical preparations. Similar variability was seen in recommendations based on a preparation-quality grading scale. Endoscopists generally recommended progressively shorter-interval follow-up as colon preparation worsened, with median recommended follow-up of 10, 5, 1, and 0.25 years for the four sets of images. No association was seen between personal demographics or practice characteristics and follow-up recommendations. When colon preparation is imperfect, gastroenterologists provide highly variable recommendations regarding timing of follow-up colonoscopy.

The Predictive Value of Pre-colonoscopy Digital Rectal Examination (DRE) on the Quality of Colon Preparation and the Completion Rate of Screening Colonoscopy

The Predictive Value of Pre-colonoscopy Digital Rectal Examination (DRE) on the Quality of Colon Preparation and the Completion Rate of Screening Colonoscopy

Two‐day Bowel Preparation With Polyethylene Glycol 3350 and Bisacodyl: A New, Safe, and Effective Regimen for Colonoscopy in Children

To assess the safety, efficacy, and acceptance of a 2-day bowel preparation with polyethylene glycol (PEG) 3350 without electrolytes and bisacodyl for colonoscopy in children. In a prospective study, 111 children of mean age 11.9 years were given 2 g/kg of PEG and a 5-mg tablet of bisacodyl daily for 2 days before colonoscopy. Stool frequency, consistency, and adverse effects were monitored for the duration of the bowel preparation. Compliance and quality of colonic preparation were assessed on the day of the colonoscopy. The average daily stool frequency increased from a baseline of 2, to 4* on day 1, and 6.5* on day 2 of the bowel preparation (*P < 0.001 for difference vs baseline). The colonic preparations were rated as excellent or good in 92% and 93% of the patients in the right and left colon, respectively. Adverse effects were mild nausea (19%), abdominal pain (11%), and vomiting (4%). The compliance was rated as excellent in 95% of the patients. A 2-day bowel preparation with PEG and bisacodyl is safe, effective, and well accepted for colonoscopy in children without any major adverse effects.