GI Unit Leadership: Optimizing Endoscopy Operations through Leadership (Virtual) | February 2025-USMSTF

USMSTF_optimizing bowel prep

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The document outlines guidelines by the U.S. Multi-Society Task Force on Colorectal Cancer to enhance bowel cleansing for coloscopy. Colorectal cancer is a major health concern being the second leading cause of cancer deaths in the U.S., but it can be mitigated with effective colonoscopy which relies heavily on the quality of bowel preparation. However, 20-25% of colonoscopies face inadequate preparation, affecting the detection of lesions, procedure time, and patient safety. <br /><br />The guideline emphasizes prioritizing cleansing efficacy over tolerability, ensuring that poor tolerance does not compromise cleansing quality. A systematic review used the GRADE system to gather expert insights, ultimately recommending methods to optimize cleansing quality and safety.<br /><br />Key Recommendations:<br />1. Split-Dosing Regimen: A split-dose bowel cleansing regimen is strongly urged for elective colonoscopy, enhancing cleansing efficacy compared to a single, previous-day dose.<br />2. Timing: The last dose should ideally be ingested 4-6 hours before the procedure. Same-day regimens might be more suitable for afternoon examinations.<br />3. Follow-Up Procedures: Incomplete cleansing requires prompt follow-up, often within a year, especially if advanced neoplasia is detected, to minimize complication risks such as missed adenomas.<br />4. Diet: Restrictions are necessary, but low-residue or full liquids are allowed up until the evening before, enhancing preparation acceptance without compromising effectiveness.<br />5. Patient Education: Adequate oral and written instructions can improve compliance and preparation quality.<br />6. Special Populations: Adjustments like avoiding sodium phosphate in elderly or renal-compromised patients are necessary; split-dosing is recommended for diabetic patients to account for diabetic delays in gastric emptying.<br /><br />The guidelines aim for ratio effectiveness with at least 85% adequate preparation rates per physician, favoring those interventions with proven evidence in enhancing proper bowel cleansing preparation for colonoscopy to aid in preventing Colorectal Cancer.

Keywords

Colorectal Cancer

bowel cleansing

colonoscopy

U.S. Multi-Society Task Force

split-dosing regimen

GRADE system

patient education

diet restrictions

special populations

cancer prevention