Morning Colonoscopy Research Articles

Magnesium citrate with a single dose of sodium phosphate for colonoscopy bowel preparation

To evaluate the efficacy and acceptability of magnesium citrate and a single dose of oral sodium phosphate (45 mL) solution for morning colonoscopy bowel preparation. A total of 159 patients were randomly assigned to receive two split doses of 90 mg of sodium phosphate (Group I, n = 79) or magnesium citrate (250 mL, the day before the procedure) followed by 45 mL of sodium phosphate (the day of procedure, Group II, n = 80). The quality of bowel cleansing and the acceptability of each regimen were compared, including the satisfaction, taste, willing to repeat and adverse effects of each regimen. The quality of bowel cleansing of Group II was as good as that of Group I (An Aronchick scale score of good or excellent: 70.9% vs 81.0%, respectively, P = 0.34; the Ottawa system score: 4.4 ± 2.6 vs 3.8 ± 3.0, respectively, P = 0.76). There was no statistically significant difference between both groups with regard to acceptability, including the satisfaction, taste and willingness to repeat the regimen. A significantly greater number of older patients (over 65 years old) in Group II graded the overall satisfaction as satisfactory (48.1% vs 78.1%, respectively; Group I vs Group II, P = 0.01). There were no significant adverse reactions. Magnesium citrate and a single dose of sodium phosphate was as effective and tolerable as the conventional sodium phosphate regimen and is a satisfactory option.

No Change in Adenoma Detection Rate (ADR) Found between Morning (AM) and Afternoon (PM) Colonoscopy (colon) in a High Volume Private Practice Setting

No Change in Adenoma Detection Rate (ADR) Found between Morning (AM) and Afternoon (PM) Colonoscopy (colon) in a High Volume Private Practice Setting

Efficacy and Tolerability of Split-Dose Magnesium Citrate: Low-Volume (2 Liters) Polyethylene Glycol vs. Single- or Split-Dose Polyethylene Glycol Bowel Preparation for Morning Colonoscopy

Preparation regimens for morning colonoscopy are suboptimal. The aim of this study was to test the efficacy and tolerance of a split-dose magnesium citrate-low-volume (2 liters) polyethylene glycol (PEG) regimen for morning colonoscopy. A total of 232 patients were randomly assigned to receive 4 liters PEG (day before procedure; group 1, n=79), 2 liters PEG (day before procedure) followed by another 2 liters PEG (day of procedure; group 2, n=80), or magnesium citrate (250 ml, day before procedure) followed by 2 liters PEG (day of procedure; group 3, n=73). The quality of bowel cleansing, tolerability, and adverse effects in group 3 were compared with those in groups 1 and 2. Satisfactory bowel preparation was more frequently reported for group 3 than for group 1 (75% vs. 51%, P=0.001) and was similar to that for group 2 (75% vs. 76%, P=0.896). A significantly greater proportion of patients in group 3 graded their overall satisfaction as satisfactory compared with group 1 (43% vs. 23%, P=0.010), and the proportion was similar to that in group 2 (43% vs. 35%, P=0.133). Patients in group 3 were more willing to repeat the same preparation regimen, if necessary, than those in group 1 (93% vs. 48%, P<0.001) or group 2 (93% vs. 62%, P<0.001). The split-dose magnesium citrate-low-volume (2 liters) PEG regimen was more efficient than and preferred to the conventional regimen of 4 liters of PEG, and it was equally efficient as, but, again, preferred to the split-dose (2+2 liters) regimen for morning colonoscopy.

Willingness to Undergo Split-Dose Bowel Preparation for Colonoscopy and Compliance with Split-Dose Instructions

Split-dose bowel preparations for colonoscopy have superior effectiveness compared with giving all the preparation the evening before colonoscopy. Some physicians believe that split-dose preparations would be unpopular with patients scheduled for early morning colonoscopies. To determine the willingness of potential patients to undergo split-dose bowel preparation for colonoscopy and the actual adherence of colonoscopy patients to split-dose instructions. We performed a survey of esophagogastroduodenoscopy patients and drivers of colonoscopy patients asking whether they would accept split-dose preparations for early morning colonoscopy appointments. We also asked colonoscopy patients scheduled in the early morning if they had complied with the written preparation instructions. Of the 300 individuals surveyed, the majority (85%) stated they would be willing to get up during the night to take the second dose of preparation. Of 107 colonoscopy patients with early morning appointments, 78% actually got up during the night to take the second dose of preparation. Acceptance of and compliance with split-dose bowel preparations is high and should not be a deterrent to prescribing split-dose preparations for colonoscopy.

Adenomas Are Detected More Often in Morning Than in Afternoon Colonoscopy

The effectiveness of colonoscopy in preventing colon cancer depends on adenoma detection and removal. Adequacy of bowel preparation, careful mucosal visualization, and adequate withdrawal time are known to affect adenoma detection rate (ADR). Physician fatigue, which usually increases as the day progresses, might impair ADR. The aim of this study is to assess the effect of timing of colonoscopy, morning vs. afternoon, on ADR. Medical records of 9,063 colonoscopies performed in 2006 were reviewed for patient demographics, indications, timing, and findings of colonoscopy. Asymptomatic outpatients who had adequate bowel preparation and complete colonoscopy were included. Morning colonoscopies were defined as those that started before 12 noon and afternoon colonoscopies as those that started after 12 noon. ADR is defined as the detection of at least one adenoma per colonoscopy. A total of 3,619 colonoscopies were included, of which 1,748 (48.3%) were done in the morning and 1,871 (51.7%) were done in the afternoon. ADR was 29.3% in the morning group compared with 25.3% in the afternoon group (P=0.008). There was a trend toward declining ADR for each subsequent hour of the day (P=0.01). In multivariable analysis, colonoscopy in the morning was significantly associated with increased ADR (odds ratio (OR) 1.2 (1.06, 1.4) P=0.006). Time of performance of colonoscopy seems to be an independent predictor for adenoma detection. ADR was significantly higher in morning colonoscopies than in afternoon colonoscopies. The reasons and implications of this finding should be studied further.

Randomized, Controlled Trial of the Use of Magnesium Citrate with Polyethylene Glycol Electrolyte Lavage Solution for Morning Colonoscopy Preparation

Introduction: Large volume of polyethylene glycol electrolyte lavage solution (PEG-ELS) for bowel preparation before colonoscopy reduces patient's tolerance and increase sleep disturbance in the patients undergoing morning colonoscopy. The aim of this study was to compare the tolerability and efficacy of three bowel preparation methods for morning colonoscopy: 4L of PEG-ELS; split-dose of PEG-ELS; and magnesium citrate plus 2L of PEG-ELS. Aims and Methods: This was a randomized, single-blinded, controlled study. Total 232 consecutive patients scheduled for outpatient elective colonoscopy were prospectively and randomly assigned to one of three preparations(Group 1(n=79): 4L of PEG-ELS at 10PM; Group 2(n=80): 2L of PEG-ELS at 8PM on the preceding day and 2L at 5AM on the day of colonoscopy; Group 3(n=73): magnesium citrate(250cc) at 8 PM on the preceding day and 2L of PEG-ELS at 5AM on the day of colonoscopy). Endoscopists were blinded to the types of preparation. The quality of bowel cleansing was rated using Aronchick scale (excellent, good, fair, poor, inadequate) and Ottawa scale. Tolerability and adverse effects of assigned preparation were evaluated by questionnaire completed by each patient before the procedure. Results: There were no differences in compliance and sleep disturbance among three groups (p=0.504, p=0.733). And compared with previous exam, the difference of sleep disturbance was not statistically significant (p=0.075). But, the frequencies of nausea and abdominal distension were much higher in Group 1 and 2 than Group 3 (p=0.002). The sum of symptom score (range 0-11) was also higher in Group 1 and 2 (p<0.0001). Satisfaction rates according to preparation method were 22.8%, 34.7% and 42.6% in Group 1, 2 and 3, respectively (p=0.004). The willingness to choose the same preparation on the next colonoscopy was 48.1%, 62% and 93.2% (p<0.001). In Aronchick scale, bowel preparation of Group 1 was relatively poorer than Group 2 and 3 (p<0.001). The proportion of fair and poor bowel preparation was 48.1%, 23.8% and 24.7%, respectively. And only in Group 1, 7 patients showed inadequate bowel preparation. In Ottawa scale, Group 1 also showed poorer preparation in right colon preparation (p<0.001). But, there was no difference in Group 2 and Group 3 (p=0.398). Conclusion: Preparatory split-dosed magnesium citrate plus 2L of PEG-ELS achieved the lowest symptom score and the highest satisfaction rate. In addition, bowel cleansing effect was superior to single-dosed 4L of PEG-ELS group and similar to split-dosed 4L of PEG-ELS group in morning colonoscopy.

Time of Day As a Risk Factor for Incomplete Colonoscopy: An Australian Tertiary Referral Hospital Experience

Background: One time colonoscopy with polypectomy has a significant reduction on expected colorectal cancer mortality. Identifying and addressing the factors that affect quality of colonoscopy are paramount. Risk factors for incomplete colonoscopy including age, gender, bowel preparation adequacy and diverticular disease have been characterised. Whether having an afternoon vs. morning colonoscopy is an independent risk for not achieving caecal intubation is less clearly defined. Questions have been raised wether proceduralist fatigue or just inadequacy of bowel preparation for afternoon procedures accounts for decreased caecal intubation rates. Methods: Retrospective single centre study of all colonoscopies performed at the John Hunter Hospital Australia from 1/1/2006 until 31/12/2006. Results: A total of 1367 colonoscopies performed. 83 colonoscopies were excluded due to patients having previous colon resection. A further 14 colonoscopies were excluded as the reason for termination of colonoscopy was obstructing tumour. There were 644 morning colonoscopies and 626 afternoon colonoscopies. There were 150 unsuccessful colonoscopies giving a caecal intubation rate of 88.1%. 43.3% of unsuccessful colonoscopies were in the morning verse 56.7% after midday (p < 0.05). 42.7% of unsuccessful colonoscopies only extended to the sigmoid or descending colon. 64.7% unsuccessful colonoscopies were in women and 35.3% in males (p < 0.05). Poor bowel preparation was reported in 41.3% of unsuccessful colonoscopies vs. 13.1% of successful colonoscopies (p < 0.05). 25% of unsuccessful colonoscopies vs. 26% successful colonoscopies had a diagnosis of diverticular disease.(P > 0.05). Multivariate analysis demonstrated that the independent risk factors for unsuccessful colonoscopy were poor bowel preparation, gender, and time of day of procedure. There was no significant interaction between these variables (P > 0.05), suggesting that time of day is an independent risk factor for failed colonoscopy. Conclusion: Time of day is an independent risk factor for not achieving caecal intubation at colonoscopy. Priority booking of colonoscopy to the beginning of procedure lists may improve this outcome and warrants prospective investigation in the Australian setting.

Comparison of morning versus afternoon cecal intubation rates

BackgroundMany factors impacting cecal intubation rates have been examined in detail; however, little information exists regarding the effect of the timing of the procedure. We sought to examine any difference in cecal intubation rates between morning and afternoon colonoscopies and identify factors contributing to a discrepancy.MethodsRetrospective, single-center study comparing cecal intubation rates for colonoscopies performed in the morning (begun prior to 12 noon) and colonoscopies performed in the afternoon (begun after 12 noon) over an approximately 12 month period. Univariate and multivariate analyses were performed evaluating patient demographics, procedure indication(s), endoscopist, bowel preparation type and quality, and participation by a gastroenterology fellow.Results6087 colonoscopies were evaluated in this study. Colonoscopies (n = 3729) performed in the morning were compared to colonoscopies performed in the afternoon (n = 2358). The crude completion rate to the cecum was 95.0% in the morning group while the completion rate to the cecum was 93.6% of the afternoon exams (p = 0.02). The morning colonoscopies had better bowel preparation quality (p < 0.001). The multivariate analyses demonstrated that gender, age, and bowel preparation quality impacted completion rates. After correcting for these factors, there was no significant difference in completion rates in the morning versus afternoon.ConclusionUncorrected cecal intubation rates were lower in the afternoon compared to the morning in outpatients undergoing colonoscopy. Bowel preparation quality was worse in the afternoon compared with the morning. Efforts at improving afternoon bowel preparation may improve the outcome of afternoon colonoscopies.

Afternoon Colonoscopies Have Higher Failure Rates Compared to Morning Colonoscopies

Background: There are several predictors of incomplete colonoscopy including poor bowel preparation, female gender, prior hysterectomy and diverticulosis. In addition, higher rates of poor bowel preparation in afternoon colonoscopies compared to morning have been reported. However, the impact of afternoon scheduling of colonoscopies compared to morning on completion rates is not well studied. Aims: To determine the influence of scheduling colonoscopies in the afternoon versus morning (before 12 noon) on completion rates of colonoscopy. Methods: Retrospective chart review of colonoscopies performed by 10 trainees under attending supervision and 8 attending physicians from November 2003 to October 2004 in the division of Gastroenterology at Metro Health Medical Center. Patient demographics, indications for procedure and colonoscopic findings were reviewed. Majority of our patients receive PEG-electrolyte based bowel preparation in the evening prior to the day of scheduled colonoscopy. Results: Inadequate bowel preparation was found in 182 out of 1114 (16%) colonoscopies in the morning and 259 out of 1174 (22%) in the afternoon (p 0.0005). Patients were similar with regards to risk factors predictive of incomplete colonoscopy except poor bowel preparation precluding completion. Incompletion rate was significantly higher in afternoon procedures compared to morning procedures (8.1% versus 4.4%; p 0.0003), odds ratio for incompletion was 1.83 (CI 1.28-2.61). After excluding incomplete colonoscopies due to poor bowel preparation and colonic pathology precluding completion, incompletion rate was still higher in afternoon procedures (4.3% versus 2.8%). Odds ratio for incompletion was 1.56 (CI 0.99-2.48) but this did not reach statistical significance (p 0.068). Conclusions: Scheduling of colonoscopies in the afternoon compared to morning is an independent predictor of incomplete colonoscopy, much of this is due to poor bowel preparation. Even after adjusting for poor bowel preparation there is a trend towards higher incompletion rates in the afternoon compared to morning. Scheduling of colonoscopies only in the morning would avoid inadequate procedures in 6% of patients and also the need for unnecessary repeat colonoscopy in 3.7% of patients. This results in cost-savings and also improvement in quality of life for the patients. Background: There are several predictors of incomplete colonoscopy including poor bowel preparation, female gender, prior hysterectomy and diverticulosis. In addition, higher rates of poor bowel preparation in afternoon colonoscopies compared to morning have been reported. However, the impact of afternoon scheduling of colonoscopies compared to morning on completion rates is not well studied. Aims: To determine the influence of scheduling colonoscopies in the afternoon versus morning (before 12 noon) on completion rates of colonoscopy. Methods: Retrospective chart review of colonoscopies performed by 10 trainees under attending supervision and 8 attending physicians from November 2003 to October 2004 in the division of Gastroenterology at Metro Health Medical Center. Patient demographics, indications for procedure and colonoscopic findings were reviewed. Majority of our patients receive PEG-electrolyte based bowel preparation in the evening prior to the day of scheduled colonoscopy. Results: Inadequate bowel preparation was found in 182 out of 1114 (16%) colonoscopies in the morning and 259 out of 1174 (22%) in the afternoon (p 0.0005). Patients were similar with regards to risk factors predictive of incomplete colonoscopy except poor bowel preparation precluding completion. Incompletion rate was significantly higher in afternoon procedures compared to morning procedures (8.1% versus 4.4%; p 0.0003), odds ratio for incompletion was 1.83 (CI 1.28-2.61). After excluding incomplete colonoscopies due to poor bowel preparation and colonic pathology precluding completion, incompletion rate was still higher in afternoon procedures (4.3% versus 2.8%). Odds ratio for incompletion was 1.56 (CI 0.99-2.48) but this did not reach statistical significance (p 0.068). Conclusions: Scheduling of colonoscopies in the afternoon compared to morning is an independent predictor of incomplete colonoscopy, much of this is due to poor bowel preparation. Even after adjusting for poor bowel preparation there is a trend towards higher incompletion rates in the afternoon compared to morning. Scheduling of colonoscopies only in the morning would avoid inadequate procedures in 6% of patients and also the need for unnecessary repeat colonoscopy in 3.7% of patients. This results in cost-savings and also improvement in quality of life for the patients.

Explosion-safe, enema-free, nutritious colonoscopy preparation using a prepackaged formula diet

Breath hydrogen and methane concentrations were normal before morning colonoscopy in 72 ambulatory patients randomly assigned to Ensure or clear liquid diet preparation for 48 hours. Mechanical bowel preparation was equal with each diet using an evening-laxative and morning-enema regimen and with Ensure using two consecutive evenings of laxatives without enemas. Ensure is an explosion-safe, mechanically acceptable, nutritionally adequate method of colonoscopy preparation. With a suitable laxative, Ensure eliminates the need for enemas in colonoscopy preparation.