Abstract
Background
Patients undergoing colonoscopy are typically provided preparation instructions. However, these are not standardized for type of bowel purgative, dietary restrictions, or management of prescription and nonprescription medications.
Aim
To examine the degree of variability in colonoscopy instructions across the USA.
Methods
Collected colonoscopy preparation instructions from endoscopy units that successfully participated in the American Society for Gastrointestinal Endoscopy’s Endoscopy Unit Recognition Program (EURP). Descriptive statistics were used to describe the variability in bowel preparation, dietary restrictions, medication instructions, and other patient advice.
Results
Preparation instructions were available from 201 (49 %) of 411 EURP units. Split dosing of bowel purgatives was used by 82 % of practices, although 79 units (39 %) offered instructions for both single- and split-dose regimens and 18 % of units relied only on single-dose regimens. Patients were restricted to a clear liquid diet on the day prior to the colonoscopy by 91 % of practices, but other specific dietary instructions (such as avoidance of nuts or legumes) varied. Instructions for the management of anti-thrombotic and anti-platelet agents, nonsteroidal anti-inflammatory drugs and diabetes medications varied widely among practices. Geographic variations in instructions were also observed. Compared to units in the northeast, units in the west were more likely to rely on split-dose preparations exclusively (p = 0.05) and units in the south were less likely to include instructions on warfarin management (p < 0.02). Units throughout the USA were less likely to specifically recommend continuing aspirin use compared to the northeast (p < 0.02).
Conclusion
Despite national recommendations for use of split-dose bowel purgatives, many practices are still relying on single-dose preparations. Clear liquid diets are widely recommended for the day prior to the colonoscopy, despite a lack of data to support the need for such a strict dietary regimen. Patients receive disparate instructions regarding the management of their medications. These findings suggest a need for more evidence-based and comprehensive colonoscopy preparation instructions.
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References
Klabunde CN, Joseph DA, King JB, White A, Plescia M. Vital signs: colorectal cancer screening test use—United States, 2012. MMWR. 2013;62:881–888.
Seeff LC, Richards TB, Shaprio JA, et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC’s survey of endoscopy capacity. Gastroenterology. 2004;127:1670–1677.
Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143:1179–1187.
Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology guidelines for colorectal cancer screening 2008. Am J Gastroenterol. 2009;104:739–750.
Hassan C, Bretthauer M, Kaminski MF, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2013;45:142–150.
ASGE Standards of Practice Committee, Anderson MA, Ben-Menachem T, et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc. 2009;70:1060–1070.
ASGE. ASGE Endoscopy Unit Recognition Program Recipients. http://www.asge.org/uploadedFiles/Clinical_Practice/Quality_Course_-_Recognition_Program_-_GIQuic/EURP%20Honoree%20Web%20Page%20List%201307(1).pdf. Accessed January 24, 2013.
Rex DK, Imperiale TF, Latinovich DR, Bratcher LL. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol. 2002;97:1696–1700.
Aoun E, Abdul-Baki H, Azar C, et al. A randomized single-blind trial of split-dose PEG-electrolyte solution without dietary restriction compared with whole dose PEG-electrolyte solution with dietary restriction for colonoscopy preparation. Gastrointest Endosc. 2005;62:213–218.
Abdul-Baki H, Hashash J, Elhajj I, et al. A randomized, controlled, double-blind trial of adjunct use of tegaserod in whole-dose or split-dose polyethylene glycol electrolyte solution for colonoscopy preparation. Gastrointest Endosc. 2008;68:294–300.
El Sayed AM, Kanafani ZA, Mourad FH, et al. A randomized single-blind trial for whole versus split-dose polyethylene glycol-electrolyte solution for colonoscopy preparation. Gastrointest Endosc. 2003;58:36–40.
Siddiqui AA, Yang K, Spechler SJ, et al. Duration of the interval between the completion of bowel preparation and the start of colonoscopy predicts bowel-preparation quality. Gastrointest Endosc. 2009;69:700–706.
Enestvedt BK, Fennerty MB, Eisen GM. Randomised clinical trial: MiraLAX vs. Golytely—a controlled study of efficacy and patient tolerability in bowel preparation for colonoscopy. Aliment Pharmacol Ther. 2011;33:33–40.
Hjelkrem M, Stengel J, Liu M, Jones DP, Harrison SA. MiraLAX is not as effective as GoLytely in bowel cleansing before screening colonoscopies. Clin Gastroenterol Hepatol. 2011;9:326–332.
Nagler J, Poppers D, Turetz M. Severe hyponatremia and seizure following a polyethylene glycol-based bowel preparation for colonoscopy. J Clin Gastroenterol. 2006;40:558–559.
Sipe BW, Fischer M, Baluyut AR, et al. A low-residue diet improved patient satisfaction with split-dose oral sulfate solution without impairing colonic preparation. Gastrointest Endosc. 2013;77:932–936.
Birnie DH, Healey JS, Wells GA, et al. Pacemaker or defibrillator surgery without interruption of anticoagulation. N Engl J Med. 2013;368:2084–2093.
Menees SB, Kim HM, Elliott EE, Mickevicius JL, Graustein BB, Schoenfeld PS. The impact of fair colonoscopy preparation on colonoscopy use and adenoma miss rates in patients undergoing outpatient colonoscopy. Gastrointest Endosc. 2013;78:510–516.
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Ton, L., Lee, H., Taunk, P. et al. Nationwide Variability of Colonoscopy Preparation Instructions. Dig Dis Sci 59, 1726–1732 (2014). https://doi.org/10.1007/s10620-014-3262-8
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DOI: https://doi.org/10.1007/s10620-014-3262-8