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New Changes in Bowel Prep Mean Good News for Patients and Doctors

colon prep

Progress and change are always interlinked, and that goes for colonoscopy preparation as well. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) has recently updated their guidelines on bowel preparation before colonoscopy. John R. Saltzman, M.D., FACP, FACG, FASGE, AGAF, from Brigham and Women’s Hospital and Harvard Medical School and co-author of the guideline told Healio Gastroenterology, “Since the time of publication of the last guideline on bowel preps, there have been substantial advances in prep quality, safety and patient tolerability.”

Among several updates and modifications which were designed to improve colonoscopy visibility and patient care, there were two notable updates on bowel preparation:

Split-Dosing of Solution

Who hasn’t heard horror stories about having to drink a gallon of Gatorade mixed with purgative the night before a colonoscopy? Drinking large volumes of fluid can contribute to feelings of nausea and bloating. Studies now show that splitting the preparation solution can be equally effective. Instead of the purgative being taken the night before the procedure, it is now recommended that colonoscopy patients take a portion of the solution the night before their procedure and the remaining dose about 3 to 8 hours before.

Low Residue Diet

The other significant change in guidelines is that a “low residue diet” is acceptable before bowel preparation instead of the dreaded “clear liquid diet. “Outcomes have proven to be as effective with a low residue diet, and patient satisfaction has definitely increased. Instead of being limited to clear broths, juices, sodas and popsicles, patients can now include foods such as:

  • White bread, refined pastas and cereals, and crackers
  • White rice
  • Vegetables without skin or seeds
  • Fruits without peels or seeds
  • Limited amounts of milk and yogurt
  • Tender meat, poultry, fish, and eggs
  • Broth-based soups (strained)
  • Jelly, honey, and syrup

The new guidelines also emphasize the importance of physicians documenting the bowel preparation quality in their patients using a validated scoring system. If patients receive low scores which reflect inadequate bowel preparation, they should be offered a repeat colonoscopy within one year. Documenting bowel preparation quality helps physicians make decisions about further education for patients and using more aggressive bowel preparations for patients who have received low scores or have a history of inadequate bowel preparation. Dr. Saltzman emphasizes that physicians are held to high standards of bowel preps in their patients. “New quality indicators demand that physicians have adequate bowel preps in at least 85 percent of their outpatients,” he said, “and it is, thus, critical for all physicians performing colonoscopy to be aware of the current state-of-the-art and science of bowel preparations.”

More often than not, change is for the better and these changes in bowel preparation should be welcome news for patients and clinicians. Hopefully, the two modifications of split-dosage and low residue diet will make the bowel preparation process more palatable for patients. This should, in turn, increase scores for bowel preparation quality. It may be too early to tell, but these new guidelines may encourage more adults to get a colonoscopy who have been previously hesitant to schedule a procedure (Source: Healio Gastroenterology).

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posted on June 24, 2015 in news