Improving Quality and Safety In Your Endoscopy Unit: On-Demand | October 2022 OLQUALOCT22-06_Levin

06_Levin_Bowel Prep

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This document discusses the optimization of bowel preparation in endoscopy units. Inadequate bowel preparation can lead to prolonged procedure time, decreased cecal intubation rates, repeat procedures, reduced detection of adenomas, and increased costs. Risk factors for poor prep include older age, male sex, higher body mass index, inpatient status, polypharmacy, tricyclic antidepressants, narcotics, diabetes mellitus, and neurologic conditions associated with poor mobility. Patient education is important and can be done through standardization, educational booklets, videos, outsourcing, texting, smartphone apps, and robocalls.<br /><br />Various purgative options are available including isosmotic full volume preps (e.g., Colyte, GoLYTELY), isosmotic low volume prep (2L PEG-ELS, PEG and ascorbic acid), hyperosmotic low volume preps (e.g., Suprep, Prepopik, Clenpiq, Sutab, OsmoPrep), and OTC products (Mg Citrate, MiraLAX). Personalized regimens can improve satisfaction and adherence, taking into account factors such as taste, volume, and mental barriers.<br /><br />Split-dose preps, where part of the purgative is taken the evening prior and the second dose is taken 4-6 hours before the procedure, have demonstrated superiority for any type of prep. Same-day preps for afternoon cases have also shown effectiveness. Dietary restriction may not be necessary and allowing a low residue diet has shown no difference in prep quality compared to a clear liquid diet.<br /><br />Assessing bowel prep quality adequacy is recommended and can be done using scoring systems such as the Boston Bowel Preparation Scale (BBPS) or Aronchick Scale. Adequate preps should be achieved in over 85% of all exams on a per-physician basis. If the benchmark is not reached, improvement initiatives should be undertaken.<br /><br />In cases of inadequate prep, options include additional prep in the facility and same-day colonoscopy, rescheduling next day with additional prep at home, or rescheduling within one year using the same or different prep. It is important to consider alternative screening modalities if needed. Overall, the key takeaway is to use split-dosing or same-day prep, grade the bowel prep after cleaning for each colonoscopy, and monitor and improve prep quality.

Keywords

bowel preparation

inadequate prep

cecal intubation rates

adenoma detection

patient education

purgative options

personalized regimens

split-dose preps

bowel prep quality

improvement initiatives