“Our guidance, which is an update of the 2014 recommendations, aims to help all gastroenterologists achieve a benchmark of 90% of exams with adequate bowel preparation,” Joseph Anderson, MD, one of the co-leading authors of the new recommendations, said in a statement. “Highlights include the use of low-volume bowel preparation and the adjunctive use of simethicone.”
Here are eight other things to know about the new recommendations:
1. The new recommendations emphasize a “patient-centered approach,” according to AJMC, which considers factors like individual medical history, comorbidities, medication use, cost, and ease of obtaining and consuming purgatives.
2. The recommendations also highlight the importance of dose timing and recommend a split-dose regiment, with the second dose of purgative taken four to six hours before the procedure and completed at least two hours before start time for morning colonoscopies.
3. A same-day regimen is accepted as an alternative for afternoon procedures, according to the recommendations, but less preferable for morning cases.
4. The recommendations also emphasize dietary restrictions for the day before the procedure in low-risk patients, including clear liquids or low-fiber, low-residue diets for mid-day meals.
5. The MSTFCRC also provides a comparative table detailing commonly used bowel prep agents, their side effects and contraindications.
6. The MSTFCRC also highlights the importance of documenting bowel preparation quality in the endoscopy report and ensuring that findings are clearly communicated using standardized descriptions. It notes that adequate bowel preparation can be used as an indicator of procedure reliability and help determine appropriate screening intervals.
7. The guidelines call for a routine tracking of bowel preparation adequacy rates with a benchmark of 90% or greater at both the individual endoscopist and endoscopy levels.
8. “Bowel preparation is a vital part of colonoscopy,” Brian Jacobson, MD, co-lead author, added in the statement. “If the colon is not adequately cleaned, the person performing the colonoscopy may miss important findings such as small polyps. Many cases end up cancelled when the bowel preparation is inadequate, and that creates tremendous frustration for patients and inefficient use of resources.”
