Improving Quality and Safety in the Endoscopy Unit (Virtual) | August 2023-04_ASGE Quality_Dominitz

04_ASGE Quality_Dominitz_Bowel Prep

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In this document, Dr. Jason Dominitz discusses the importance of optimizing bowel preparation in endoscopy units. Inadequate bowel preparation can lead to prolonged procedure times, decreased cecal intubation rates, repeat procedures, increased costs, and reduced detection of adenomas. Risk factors for poor prep include older age, male sex, higher body mass index, inpatient status, polypharmacy, diabetes mellitus, and certain medications. There are various options for patient education, including educational booklets, videos, texting, and smartphone apps.<br /><br />Different types of bowel preps are available, such as isosmotic full and low volume preps, hyperosmotic low volume preps, and over-the-counter (OTC) products like magnesium citrate and MiraLAX. Personalized regimens can improve patient satisfaction and adherence. 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 been shown to be superior in terms of satisfactory colon cleansing, willingness to repeat the same prep, and reduction in nausea.<br /><br />There is debate over whether dietary restriction is necessary prior to colonoscopy. Some studies have shown that allowing a low residue diet (LRD) for breakfast and lunch on the day prior to colonoscopy yields no difference in prep quality compared to a clear liquid diet. The US Multi-Society Task Force (USMSTF) recommends individualizing the choice of prep, using split-dose or same-day prep, and allowing LRD or full liquids until the evening prior.<br /><br />Bowel prep quality adequacy is recommended as a quality metric, with a target of achieving more than 85% adequate preps in outpatient examinations. The Boston Bowel Preparation Scale (BBPS) and Aronchick Scale are commonly used to grade prep quality. The USMSTF also provides recommendations for managing inadequate prep, including rebooking the procedure, prescribing a more intensive regimen, or considering alternative screening modalities.<br /><br />Overall, best practices in bowel preparation include enhanced patient instructions, standardized scoring systems, routine measurement of prep adequacy, and individualizing the choice of prep based on the patient's factors. Split-dose or same-day prep, with consideration of diet liberalization, can improve patient adherence and satisfaction.

Keywords

bowel preparation

endoscopy units

inadequate bowel preparation

cecal intubation rates

repeat procedures

risk factors

patient education

split-dose preps

dietary restriction

prep quality adequacy