alexa Optimizing Bowel Preparation Schedule Can Improve the Bowel Cleansing Effect and Adenoma Detection Rate at Colonoscopy

Journal of Colitis & Diverticulitis

  • Short Communication   
  • J Colitis Diverticulitis 2016, Vol 1(1): 101

Optimizing Bowel Preparation Schedule Can Improve the Bowel Cleansing Effect and Adenoma Detection Rate at Colonoscopy

Jui-Wen Kang1,2, Chiung-Yu Chen2 and Chiao-Hsiung Chuang2*
1Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
*Corresponding Author: Chiao-Hsiung Chuang, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Tel: 886-6-2353535, Email: [email protected]

Received Date: Dec 16, 2015 / Accepted Date: Jan 06, 2016 / Published Date: Jan 09, 2016

Optimizing Bowel Preparation Schedule

Colonoscopy is widely used for colorectal cancer screening, but up to 9% of colorectal cancers are interval cancer and most of them are attributed to missed lesions [1]. Because the risk of interval cancer is reversely associated with adenoma detection rate (ADR), improvement of ADR is important in order to achieve its protective effect. There are many ways to improve ADR, such as longer withdrawal time, education of endoscopist, upgrade of the equipment, etc. Our recent study demonstrated that by merely changing the schedule of bowel preparation can effectively increase the colonic ADR in a health management center [2].

Many studies have approved that split-dose bowel preparation schedule not only is more tolerable, but also has better colonic cleansing effect, especially the right side colon [3]. The key-point is the timing of the second dose of cleansing agent that a shorter preparation-to-colonoscopy interval yield better bowel cleansing quality [4]. The recent guideline from American society of gastrointestinal endoscopy (ASGE) recommend the second dose of bowel cleansing agent should be taken within 3 to 8 h before colonoscopy, and European society of gastrointestinal endoscopy (ESGE) advise the interval should be no longer than 4 h [5,6]. The high quality of bowel preparation could be a cornerstone to improved ADR. The final goal of screening or surveillance colonoscopy is to reduce the disease burden and mortality rate of colorectal cancer [7,8]. To decrease of ADR could be a short-term goal because each 1% increase in ADR is associated with 3% decreased in risks of interval cancer and 5% decrease in cancer mortality [9]. Our study shows the modification of preparation schedule not only get a greatly better cleansing quality but also improve the ADR [2]. It indicates that improvement of colonoscopy quality can be achieved by simply optimizing the schedule of bowel preparation.

In the patients with morning appointment, the second dose of the cleansing agent are usually administrated between 5 AM and 7 AM [3]. Considering that the duration of cleansing agent and participants needed to arrive at hospital before 8 AM, our study set the time of the second dose at 4 AM. One may suggest it is too early to have adequate compliance. Nevertheless, more than 85% of participants could comply with the time schedule [2]. Unger et al also show the patient express willing to awaken at 2 to 3 AM to complete the regimen when educated on the advantage of the schedule on cleansing effect [10].

In summary, ADR is a crucial indicator on high quality colonoscopy to achieve the protective effect on screening colonoscopy. Optimizing the schedule of bowel preparation to shorter the time interval between preparation and colonoscopy is feasible and effective to accomplish a better bowel preparation and higher ADR.

References

Citation: Kang JW, Chen CY, Chuang CH (2016) Optimizing Bowel Preparation Schedule Can Improve the Bowel Cleansing Effect and Adenoma Detection Rate at Colonoscopy. J colitis diverticulitis 1:101.

Copyright: ©2015 Chuang CH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Review summary

  1. Dakota Cowan
    Posted on Sep 15 2016 at 11:54 am
    This will add impetus to the current literature for split bowel preparation. Whether the main study of intent was done in an inpatient setting vs outpatient setting as there can be some challenges that can be expected with outpatient setting like compliance of patients with 4 AM bowel preparation(waking up early to take bowel prep); in the hospital setting it might be feasible with the help of nurses and the compliance rate might be greater than 85% as it was mentioned(with 4 Am bowel prep).

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