Quality Of Colonic Preparation Research Articles

Evaluation of parameters influencing the quality of colon preparation with a split-dose regimen of sulfate salts.

Bowel cleansing is an important factor for the quality of colonoscopy. We aimed to evaluate the efficacy of split-dose oral sulfate salts on bowel preparation and to determine parameters influencing the quality of bowel cleaning. Consecutive adults who completed their preparation for colonoscopy with a regimen of sulfate salts were enrolled. Of the 446 patients, 11 were excluded from the analysis. Among the 435 patients, 257 (59.1%) were female, mean age was 62.0±11.6 years and median body mass index (BMI) 26.1 kg/m2 (interquartile range [IQR] 23.8-29.4). Indications for colonoscopy were screening 155 (35.6%), surveillance 102 (23.5%), or other 178 (40.9%). The median time between the end of second dose of the preparation regimen and colonoscopy initiation was 5:15 h (IQR 4:30-6:00, min: 2:20, max: 12:20). Minor adverse events were reported in 62 (14.3%) patients. BBPS=9 was observed in 279 (64.14%) patients. Segmental BBPS=3 was achieved in 387 (88.97%), 346 (79.54%) and 289 (66.44%) patients (P<0.001) in the descending, transverse and ascending colon, respectively. Multivariate analysis revealed that BMI (odds ratio [OR] 1.05, 95% confidence interval [CI] 1-1.1) and time between the end of the second laxative dose and colonoscopy initiation (OR 1.25, 95%CI 1.08-1.45) were associated with poorer bowel preparation. A split dose of oral sulfate salts is an efficacious and well tolerated regimen. Obesity and a longer time interval between the end of the second dose and colonoscopy initiation negatively influence bowel cleanliness.

Efficacy of single-versus split-dose polyethylene glycol for colonic preparation

Background: Before a colonoscopy, polyethylene glycol (PEG) is often used to prepare the colon. PEG dosage recommendations are still up for discussion. In this randomized controlled experiment, the effectiveness and acceptability of PEG administered in single vs. split doses for colonic preparation was compared. Methods: A total of 120 individuals were randomized to either split-dose PEG for colonic preparation or a single-dose PEG at Department of Gastroenterology, Hayatabad medical complex. The Boston Bowel Preparation Scale (BBPS) was used for assessing the rate of bowel cleaning for the colonoscopy. A visual analog scale was used to evaluate the preparation's acceptability and tolerability. Results: The quality of colonic preparation was considerably greater in the split-dose PEG group than in the single-dose PEG group, as shown by the BBPS score, which was significantly higher in the split-dose PEG group (7.5±1.2) than in the single-dose PEG group (6.3±1.3) (P0.001). Patient satisfaction did not vary significantly between the two groups, but the split-dose PEG group had a higher completion rate of colonoscopies (97% vs. 95%) as well as greater patient acceptability and tolerance.

Impact of Multimedia CD Education on the Quality of Colon Preparation; A Single-Blind Randomized Study.

Background: Routine bowel preparation instructions are usually given to patients in the form of oral explanations with written instructions. The purpose of this study was to evaluate the effectiveness of multimedia training in the form of video CDs on the quality of colon preparation and other related indicators. Methods: 201 outpatients in three referral academic colonoscopy centers were randomly assigned to two groups. The first group (n=100) received supplementary video CD education besides the routine instructions (VCD group). The second group (n=101) received only routine instruction, which included oral and printed instructions (non-VCD group). Results: Complete use of colon cleansing medication was statistically and significantly better in the VCD group (P=0.038). Duration of colonoscopy was shorter in the VCD group (P=0.001), demand for conscious sedation was lesser in the VCD group (P=0.049), and the quality of colon preparation was better in the VCD group (P<0.00). There was no statistically significant difference in pain sensation (P=0.1), cecal intubation rate (P=0.3), and technical difficulty of the colonoscopy (P=0.1) in both groups. Conclusion: Supplementary education in the form of multimedia CD increases the patients' compliance to cleansing mediation consumption, improves the quality of bowel preparation, and decreases the duration of colonoscopy with lesser demands for conscious sedation.

Low volume polyethylene glycol combined with senna versushigh volume polyethylene glycol, which regimen is better for bowel preparation for colonoscopy? A randomized, controlled, and single-blinded trial.

Background and AimsBowel preparation affects the quality of colonoscopy. Reaching the optimal preparation has been a challenge for years. Polyethylene glycol (PEG) is the sole FDA‐approved substance for this purpose. However, patients find it unpleasant and often complain about its adverse effects. In this study, we aimed to reduce these complaints by lowering the amount of PEG and adding senna which is an herbal stimulant laxative.MethodsFour hundred and eighty‐six patients were admitted for colonoscopy. Finally, 382 patients were enrolled in the study and we divided them into two groups; 186 patients were placed in which conventional high volume PEG‐alone regimen was consumed and 196 patients in which low volume PEG plus senna regimen was offered. The quality of colon preparation was compared between the two groups by independent two samples t‐test (or its corresponding nonparametric test), Fisher's exact, or χ 2 test in SPSS software version 22.ResultsThe colon preparation quality was equally efficient in the two groups as 69.36% in the high volume PEG group and 71.94% in PEG plus senna group had adequate bowel preparation (p = 0.58). Adverse effects, like nausea, bloating, headache, and sleeplessness were significantly less in the low volume PEG plus senna group.ConclusionBesides the fact that bowel preparation by low volume PEG plus senna combination was noninferior to the conventional high volume PEG‐alone regimen, the side effects were much less common with the low volume PEG plus senna regimen.

Clinical Yield of Ileal Intubation During Screening Colonoscopy.

ObjectivesIleal intubation during screening colonoscopy can serve as supportive evidence of complete examination. However, most studies conducted in Western countries showed a limited value of ileal inspection in asymptomatic patients undergoing colonoscopy. Therefore, our aim is to determine the clinical yield of routine ileal examination during the performance of screening colonoscopy in a cohort of patients in the Middle East and identify factors associated with successful ileal intubation in this setting.MethodsA retrospective review of a prospectively collected database of all screening colonoscopies was performed at a single endoscopy unit. The patients were divided into two groups; group A included patients in whom the extent of examination was the cecum and group B comprised of those who underwent ileal intubation as well. We summarized the endoscopic and pathological findings of the ileoscopic examinations and their clinical impact. Univariate and multivariate analyses were used to compare both groups and to identify factors predictive of ileal intubation in the setting of screening colonoscopy. ResultsTwo thousand four hundred seventy-three unique completed screening colonoscopies were analyzed (group A=1465 patients, group B=1008 patients). Overall Ileal intubation rate was 40.8%. Of the patients in group B, 3.7% were noted to have findings on ileoscopy, which were deemed to be clinically significant in almost half (1.8% overall). Univariate analysis identified the following factors as being predictive of ileal intubation during screening colonoscopy: patients' age (51.7 vs. 53.5 years, p<0.001), short cecal insertion time, endoscopists' specialty (gastroenterology 42.3% vs. surgery 24.3%, p<0.001), type of colonoscope (pediatric 47.1% vs. adult 33.5% colonoscope, p<0.001), and quality of preparation in the right colon (poor vs. adequate/good : (25.6% vs. 42.5%, p<0.001). Mixed-effects logistic regression identified patients' age, endoscopist specialty, quality of right colon preparation, and cases with short insertion time as independent variables predicting ileal intubation during SCConclusionThe clinical yield of routine ileal intubation during screening colonoscopy is low. Ileal intubation during screening colonoscopy in our cohort was more likely in younger patients with adequate/good right colon preparation and when the exam is performed by a gastroenterologist, in cases with short insertion time. Prospective studies are needed to assess our research findings and to determine the clinical value of routinely intubating terminal ileum during screening colonoscopy in the population of the Middle East.

A comprehensive intervention to enhance inpatient colon preparation quality for colonoscopy.

Adequate colon preparation is a critical component of high-quality colonoscopy especially for inpatients undergoing colonoscopy for acute indications. Inpatient colonoscopy has a high incidence of inadequate preparations. We report implementation of a multifaceted quality improvement intervention to improve inpatient colonoscopy preparations. Bowel preparation quality from inpatient colonoscopies performed for the 12 months prior to the comprehensive intervention were compared to colonoscopies performed for 12 months following the intervention. The intervention had multiple components including: 1) EMR-based colonoscopy preparation order set; 2) automated EMR alerts prompting nursing assessment of preparation progress; 3) standardized nursing charting processes for tracking preparation progress; and 4) standardized education for nursing staff and ordering providers on adequate colon preparation, assessment of colon preparation quality, and use of the above processes; and print and video patient education materials. Two hundred thirty-eight inpatient colonoscopies were performed in the preintervention assessment period and 163 colonoscopies in the postintervention period. Median preintervention Boston Bowel Preparation Score (BBPS) was 6 and 26% of patients had inadequate colon preparation. Median postintervention BBPS was 8 with 16% inadequate colon preparation (P=0.016). The postintervention group had less ASA class I patients and used a lower dose of fentanyl than the preintervention group. There were no other significant differences between the pre- and postintervention groups. Implementation of a comprehensive colon preparation quality intervention resulted in significantly improved inpatient colon preparation quality and decreased frequency of inadequate preparations. The intervention consisting of an EMR-based order-set, nursing alerts and charting process, and patient education materials is continually being refined.

Are bedside colonoscopies performed in intensive care unit really useful?

Effectiveness of bedside Colonoscopies in Intensive Care Unit (CICU) might be limited by the poor quality of colonic preparation, and their feasibility. We sought to describe the indications and the profitability of CICU. Retrospective, bicenter observational study (2004-2015) in unselected critically ill patients. We questioned the clinical profitability of CICU, according to its indications and preparation. One hundred and eleven CICU were performed in 84 patients (sex ratio 1.4, 49M/35F; age 72.9years [61.7-84.7]), for lower gastro-intestinal bleeding in 67 patients (LGIB, 60.3%) and for other causes in 44 (39.6%). The profitability was more frequent when CICU was performed for another reason than LGIB (75% vs 28.3%; p<0.0001). Preparation was good in 47 procedures (42.3%) and allowed 33 complete CICU (29.7%). Fifty-six CICU (50.4%) were performed as a 2nd investigation after a contrast enhanced computed tomography. Three CICU were complicated by 3 hemodynamic and 2 respiratory failures, but none of them were fatal. CICU is clinically useful in half of cases, in the diagnostic and the therapeutic management of critically ill patients. Its profitability is close to scheduled colonoscopies and superior in non-lower gastro-intestinal bleeding indications.

Low-Fibre Diet as an Option for Bowel Preparation Prior to Colonoscopy: ARandomised Controlled Clinical Trial

Introduction: Bowel preparation for colonoscopy plays an important role in the evaluation of the colon. Many methods for preparing the colon for colonoscopy do not work well. Aim: To use a low-fibre diet as a standard and applicable method for bowel preparation in performing colonoscopy and increasing patients’ adherence to colonoscopy. Materials and Methods: Clinical control trial design was used to compare bowel preparation in people receiving a low-fibre diet with those who did not receive food {Nil Per Os (NPO)} for bowel preparation. The participants included 477 patients who were randomly divided into two groups including 223 patients having a low-fibre diet (for dinner) and 254 patients having nothing for dinner (NPO). Data were recorded including age, sex, weight, height, level of education, bowel preparation score, colonoscopy diagnosis and sedative dose. Both groups were given a solution of 3 L of ethylene glycol and 60 mg of bisacodyl at three occasions: 3 pm and 7 pm the day before colonoscopy and 6 am on the colonoscopy day. Scoring criteria for colonoscopy preparation included excellent (clean and free of any liquids), very good (clean with clear fluid, underlying mucus visible in clear fluid), good (clean with dirty liquid), poor (with particles including stools, but can be assessed at 80% mucus), and very poor (containing stool particles, and mucosal evaluation below 80%, colonoscopy was cancelled in this group). The data were analysed by SPSS version 21.0 using Chi-square and Independent Samples Test. Results: About 82% of patients who consumed a low-fibre diet for bowel preparation the night before colonoscopy had an excellent and very good quality of bowel preparation compared with 74.9% of patients not receiving any diet. The number of patients who cancelled the colonoscopy were more in the group not receiving any diet (4.7% versus 2.6%). The data indicated that the quality of colon preparation decreased by age (p=0.0001), whereas Body Mass Index (BMI) did not differ on colon cleansing. When having dinner, patients with Irritable Bowel Syndrome (IBS) had significantly more secretion of air bubble and foam formation than patients not eating dinner (p=0.002). The results showed that the difference in bowel preparation quality between the two groups was not significant (p=0.169), and increased patient adherence to colonoscopy in the first group. Conclusion: Implementing a proper bowel preparation method is very important in improving the quality of colonoscopy and increasing the patient’s adherence to colonoscopy. Using a low-fibre diet on the day before colonoscopy can help achieve this goal.

Effect of bowel preparation volume in inpatient colonoscopy. Results of a prospective, randomized, comparative pilot study

BackgroundInpatient status has been shown to be a predictor of poor bowel preparation for colonoscopy; however, the optimal bowel preparation regimen for hospitalized patients is unknown. Our aim was to compare the efficacy of bowel preparation volume size in hospitalized patients undergoing inpatient colonoscopy.MethodsThis prospective, single blinded (endoscopist), randomized controlled trial was conducted as a pilot study at a tertiary referral medical center. Hospitalized patients undergoing inpatient colonoscopy were assigned randomly to receive a high, medium, or low-volume preparation. Data collection included colon preparation quality, based on the Boston Bowel Preparation Scale, and a questionnaire given to all subjects evaluating the ability to completely finish bowel preparation and adverse effects (unpleasant taste, nausea, and vomiting).ResultsTwenty-five colonoscopies were performed in 25 subjects. Patients who received low-volume preparation averaged a higher mean total BBPS (7.4, SD 1.62), in comparison to patients who received high-volume (7.0, SD 1.41) and medium-volume prep (6.9, SD 1.55), P = 0.77. When evaluating taste a higher score meant worse taste. The low-volume group scored unpleasant taste as 0.6 (0.74), while the high-volume group gave unpleasant taste a score of 2.2 (0.97) and the medium-volume group gave a score of 2.1 (1.36), P < 0.01.ConclusionIn this pilot study we found that low-volume colon preparation may be preferred in the inpatient setting due its better rate of tolerability and comparable bowel cleanliness when compared to larger volume preparation, although we cannot overreach any definitive conclusion. Further more robust studies are required to confirm these findings.Trial registrationThe Affect of Low-Volume Bowel Preparation for Hospitalized Patients Colonoscopies. Trial registration: NCT01978509 (terminated). Retrospectively registered on November 07, 2013.

A meta-analysis of randomized controlled trials of the addition of lubiprostone to bowel preparation before colonoscopy.

Aim:Adequate bowel preparation is essential to the quality of colonoscopy. We performed a meta-analysis to determine the efficacy and safety of the addition of lubiprostone to the bowel preparation process prior to colonoscopy.Methods:Online databases, namely, PubMed, MEDLINE and Cochrane Library, were searched for randomized controlled trials that assessed the additive effect of lubiprostone on the quality of colon preparation in patients undergoing colonoscopy. Each included study was evaluated by the Jadad score to assess the quality of the study. The primary outcome was bowel preparation efficacy, defined as the proportion of patients with an excellent or poor preparation. The secondary outcomes included the length of the colonoscopy, polyp detection, and any adverse effects.Results:In total, 5 articles published between 2008 and 2016 fulfilled the selection criteria. The addition of lubiprostone to the bowel cleansing process significantly increased the proportion of patients with an excellent preparation (risk ratio [RR] = 1.68, 95% confidence interval (CI): 1.40–2.02, P < .00001) but did not decrease the procedural time or increase the polyp detection rate (mean difference = -0.52, 95% CI: -3.74–2.69, P = .75; RR = 1.16, 95% CI: 0.96–1.42, P = .13, respectively). There was no significant difference in the proportion of patients with any adverse events.Conclusion:The addition of lubiprostone to the bowel preparation regimen prior to colonoscopy is effective and safe.

Colonoscopy preparation quality in diabetic patients

Aim: Colonoscopy is the established standard method for the evaluation of the colon. It has been reported that diabetes was associated with poor bowel cleansing and colorectal cancer in some studies. We aimed to evaluate the bowel preparation quality of type 2 diabetic and non-diabetic patients.Material and Methods: I62 diabetic and 65 non-diabetic patients were enrolled in this study and colon preparation quality was evaluated for each segment of colon (right, transverse and left) and total score was obtained according to Boston Bowel Preparation scale.Results: The successful bowel preparation rates were 64.5% in the diabetics and 75.4% in the non-diabetics, which wasn’t statistically significant. Cecal intubation rate was 80.6% in the diabetics, 90.8% in the non-diabetics and mean cecal intubation time was 7.78 min in diabetics, 8.9 min in non-diabetics. There were no significant differences in terms of cecal intubation time, cecal intubation rate and polyp detection rates between groups. We also found that bowel cleansing of right colon and transverse colon in the non-diabetics was superior to diabetics. Conclusion: Diabetes isn’t a negative factor for detection of colonic polyps and isn’t associated with inadequate bowel cleansing, but it associated with poor bowel cleansing in right and transverse colon, so physicians must be further careful for the possibility of obscure lesions of right and transverse colon in diabetic patients.

Strategies to Improve Inpatients' Quality of Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis.

Background and Aims Inpatients' bowel preparation before colonoscopy is frequently inadequate, and various interventions have been investigated to improve it, so far. We aimed to evaluate the efficacy of various interventions to improve inpatients' colon preparation quality. Methods We systematically reviewed the literature for publications on interventions aiming to improve the quality of inpatients' colon preparation until June, 2018. Significant heterogeneity—measured with I 2—was detected at the level of P < 0.1. Adequacy rates were measured using inverse variance, and the size effect of different interventions was calculated using random effects model and expressed as odds ratio (OR). Results Seventeen studies enrolling 2733 inpatients were included. Overall, 67% (60-75%) of the participants achieved adequate colon cleansing (I 2 = 97%; P < 0.001). In six studies assessing the impact of educational interventions to patient/physician/nurse vs. no intervention, adequate bowel preparation was achieved in 77% (62-91%) vs. 50% (32-68%) of the patients (OR (95%CI) = 3.49 (1.67-7.28), P = 0.0009; I 2 = 74%; P = 0.002). Ten studies examined variations (qualitative and/or quantitative) in bowel preparation regimens with adequate preparation detected in 71% (60-81%) of the participants, and a single study examined the administration of preparation through an esophagogastroduodenoscope, resulting in adequate prep in 71% of the patients. Conclusions Despite several interventions, only two-thirds of inpatients achieve adequate colon preparation before colonoscopy. Educational interventions significantly improve inpatients' bowel preparation quality.

Preparation of the intestine for colonoscopy of women with reproductive system pathology

Aim: to evaluate the efficacy of Picoprep for colonoscopy preparation in women with pelvic pathology.Patients and methods: during the period from January 2018 to December 2018 in the Federal State Budgetary Institution «National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I.Kulakov’’ of the Ministry of Health of the Russian Federation, 873 diagnostic video-colonoscopies were performed on women of reproductive age (from 23 to 41 years of age) in the surgical department of the Department of Operational Gynecology and General Surgery. Macrogol and Picoprep were used in preparation for the study. 512 (58.7%) of the total number of performed colonoscopies were performed after colon preparation with Picoprep.Results: quality of colon preparation with Picoprep: excellent – 168 (32.7%), good – 275 (53.7%), satisfactory – 66 (13%), unsatisfactory – 3 (0.6%).Conclusion: The effectiveness of Picoprep does not differ from the quality of preparation with the use of alternative preparations of Macrogol, but significantly exceeds them in tolerability by patients.

Possibilities of using phospho-soda in patients with complicated colon preparation for endoscopy

Endoscopic screening is the main method of colon examination. An important factor for the accurate diagnosis of various pathological changes in the mucous membrane of the lower part of the digestive tract is the degree of its visualization, which directly depends on the quality of preparation for colonoscopy. There are many colon cleansers, but the peristaltic motion of the gut slows down in various diseases and syndromes, which results in the reduced accuracy of endoscopy.The paper presents the analysis of colon preparation quality using Phospho-soda (Casen Recordati, S.L., Spain) for colonoscopy in 198 patients with pathological conditions that impedes passage of all bowel contents: inflammatory bowel disease, acromegaly, and hypotonia of the large intestine. The authors carried out a comparative analysis with a control group, which included 106 patients without factors that slowed down the peristaltic motion of the intestine, who were preparing for endoscopic examination according to a similar scheme.The study showed that using Phospho-soda to prepare for endoscopic examination in patients with decreased colonic tone resulted in the efficacy of the drug comparable with its efficacy in a group of patients without dysmotility.

Pain Intensity and Difficulty of Colonoscopy in Patients with Irritable Bowel Syndrome Compared to Patients with Other Diagnoses

Background: Irritable bowel syndrome (IBS) is one of the most common functional disorders of gastrointestinal system. The diagnosis of IBS is made by ROME criteria while excluding other organic causes of symptoms. The presence of alarming sings warrants further evaluation by radiologic or endoscopic studies. It is a common belief among gastroenterologists that colonoscopy in the IBS patients (compared to other patients) is more difficult for the colonoscopists and more painful for the patients. The present study aimed at evaluating the difficulty of colonoscopy, intensity of pain sensation, quality of bowel preparation, and other related findings in the IBS patients compared to non-IBS patients. Methods: This study was conducted during January and May 2016 in a single referral academic colonoscopy center in Shiraz University of Medical Sciences on referring adult patients who were classified into 2 groups, IBS and non-IBS. Duration of procedure, quality of colon preparation, severity of pain, and difficulty of the procedure assessed by Visual Analogue Scale (VAS) were the main assessed parameters. Statistical analysis was performed by SPSS software Version No.16, and independent t test was used to compare the means. Results: In this study, 172 patients (59 males and 113 females) were enrolled and allocated into 2 groups, IBS: 72, non-IBS:100. The mean age in IBS and non-IBS groups was 43.4 and 46.6 years, respectively. Although IBS patients had a more statistically significant pain sensation than non-IBS patients during the procedure (5 vs. 4.4 in VAS, P = 0.03), the quality of colon preparation and difficulty of the procedure revealed no significant differences (7.5 vs. 7.2, P = 0.23; and 4.7 vs. 4.8 in VAS, P = 0.6, respectively). The duration of procedure was significantly lower in the IBS group (13.1 vs. 14.1 minutes, P = 0.006), while the success rate for cecal intubation was similar in both groups (97% vs. 95%, P = 0.7). Conclusions: Our results showed that IBS patients had more pain sensation during the colonoscopy, but the procedure itself was not more difficult in this group of patients. Finally, with a similar success rate the duration of colonoscopy was shorter in IBS patients.

Mechanical colon cleansing for screening colonoscopy: A randomized controlled trial.

Effective screening colonoscopy depends on the quality of colon preparation. This study aimed to compare pulsed irrigation evacuation (PIE), polyethylene glycol (PEG) and sodium phosphate colon preparations. Outpatients at a VA hospital were randomized using sealed envelopes. Preparations consisted of polyethylene glycol 4L, Fleet sodium phosphate 90 mL with four to six glasses water twice daily and 296 mL of magnesium citrate in the evening with PIE prior to colonoscopy. Colon cleansing was assessed blindly using a five-point scale: 0 (very poor) to 4 (excellent). Altogether 391 patients participated in the study (129 in the PEG group, 127 in the sodium phosphate and 135 in the PIE group), with a mean age of 62 years, of whom 75% were men. PIE and sodium phosphate were superior to PEG: median cleansing scored 4 (excellent) versus 3 with PEG (P < 0.01). Inadequate preparations were more common with PEG than PIE (18% vs 5%) (P < 0.01). Side-effects included vomiting: 37% in the sodium phosphate group versus 5% in the PEG and 2% in the PIE groups (P < 0.01). The three preparations were judged intolerable in ≤ 5%. PIE and sodium phosphate are superior to PEG for colon preparations. PIE is the preferred preparation for those at high risk of unsatisfactory preparations or with unsatisfactory traditional preparations.

Issue Highlights

Issue Highlights

Intérêt des scores endoscopiques dans la prise en charge des maladies inflammatoires chroniques de l’intestin

Mucosal healing is the goal to achieve in IBD. Calculating an endoscopic score in IBD is a good reflect of mucosal activity and is useful in therapeutic strategy to assess response to treatment. Calculating endoscopic score, precise description of mucosal lesions, quality of colonic preparation and the number of explored segments are necessary in every endoscopic report.

Clinical value of split-dose polyethylene glycols combined with simethicone for morning colonoscopy preparation

Objective To evaluate the performance of split-dosed polyethylene (PEG) combined with simethicone in bowel preparation for morning colonoscopy. Methods A total of 293 patients scheduled for morning colonoscopic examination were randomly assigned to receive either split-dosed 3 liter of PEG (2 L in the evening before examination and 1 L in the morning of examination)and 15 ml simethicone (Group A, n=147), or whole dose of 3 L PEG (the evening before examination) without simethicone (Group B, n=146). Bowel preparation quality, adenoma detection rate and patients′ acceptance were compared between groups. Results Group A had higher Boston Bowel Preparation Scale in overall colon (6.9 ± 3.1 VS 6.2 ± 2.8, P=0.032) and better preparation quality of right-side colon (2.6 ± 1.0 VS 2.0 ± 0.9, P=0.041). Adenoma detection rate was comparable between groups (31.3% VS 29.5%, P=0.796), but group A detected more small adenomas (≤1.0 cm) (64.5% VS 50.7%, P=0.043) and showed a improving trend for more right-side adenomas (32.3% VS 18.6%, P=0.075) than group B. More participants completed bowel preparation in group A than those in group B (98.6% VS 93.1%, P=0.020). Group A had fewer patients undergoing adverse events such as nausea and vomiting and fewer participants refusing to repeat colonoscopic examination (6.1% VS 13.7%, P=0.033) if necessary. Conclusion Split-dose PEG combined with simethicone can yield to better colon cleansing, detect more adenomas and ensure higher patient compliance. Key words: Adenomatous polyposis coli; Polyethylene glycols; Simethicone; Colonoscopy

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

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