ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence

13_Williams_The Dirty Colon

Pdf Summary

The document, authored by Dr. Renee Williams, explores critical aspects of colonoscopy quality, emphasizing the significance of adequate bowel preparation. Key points include various assessment scales, risk factors for inadequate preparation, and strategies to improve preparation efficacy and quality metrics, such as the Boston Bowel Prep Score (BBPS), with a target adequacy rate of 90%.<br /><br />The paper highlights risk factors, including prior inadequate preparation, constipation, certain medications, and medical conditions like obesity and diabetes. It stresses the importance of adequate pre-colonoscopy bowel preparation to ensure a thorough examination and highlights the use of different strategies to optimize it.<br /><br />Comparisons between different preparation methods show that split-dose regimens of polyethylene glycol (PEG) are more effective than single-dose preparations. Split-dose regimens increase preparation adequacy, polyp detection rates, and patient compliance while being well-tolerated. Further, although low residue and clear liquid diets show no significant difference in preparation outcomes, split-dose regimens outperform single doses significantly.<br /><br />The paper also discusses an innovative intraprocedural cleansing system, the Pure-Vu EVS System, which helps improve inadequate preparations during colonoscopy using high-intensity water jets and suction without obstructing the working channel.<br /><br />To enhance the preparation process, best practices are suggested, advocating for clear communication with patients through various modalities, educational resources in multiple languages, and regular assessment of preparation adequacy.<br /><br />A practical example of quality improvement is given, showing the effectiveness of combining split-prep and instructional booklets to significantly raise preparation adequacy from 67% to 94%. This indicates that integrating structured education and preparation methods can substantially improve colonoscopy outcomes, promoting enhanced patient care and cancer prevention through better polyp detection.

Keywords

colonoscopy quality

bowel preparation

Boston Bowel Prep Score

risk factors

split-dose regimens

polyethylene glycol

Pure-Vu EVS System

patient compliance

preparation adequacy

polyp detection