New guidelines for optimizing intestinal preparation in colonoscopy procedures

The latest consensus recommendations by the US Multisocial Task Force on Colorectal Cancer (MSTFCRC) optimize the quality of colonoscopy intestinal preparation. This document presents clinical strategies to improve intestinal preparation applied before, during and after colonoscopy.

MSTFCRC provides evidence-based recommendations and important concepts on topics such as patient education and voyage, dietary restrictions, preparatory agent selection, timing and amount of doses, the routine use of irrigation pumps to assist in gut purification during colonoscopy, and same-day salvage operations for inadequate preparation. When recognizing intestinal preparation validity as a quality measure, the authors recommend a “rational benchmark” of 90% or higher at both the individual endoscope and endoscope unit levels. While most of the MSTFCRC recommendations focus on outpatients with low risk of inadequate intestinal lavage, statements are also provided that address people at risk of inadequate intestinal preparation quality.

The MSTFCRC includes representatives from three American GI Society, the American Gastroenterology (ACG), the American Gastrointestinal Association (AGA), and the American Gastrointestinal Endoscopy Association (ASGE). This consensus document is published online today in each of the three societies' scientific journals.

“Colorectal cancer remains the second most common cause of cancer death in the United States, and colonoscopy is considered the gold standard for assessing the causes of colon-related signs and symptoms and including detection of precancerous lesions. It is well recognized that the validity of intestinal preparation is essential for optimal colonoscopy performance.

Our guidance, which is the latest in 2014 recommendations, aims to help all gastroenterologists achieve a 90% benchmark for exams with appropriate intestinal preparation. Highlights include the use of hypovolume intestinal preparations and the supplemental use of simethicone. ”

Joseph C. Anderson, one of the co-lead authors recommended by MD, FACG and MSTFCRC

“Intestinal preparation is an important part of colonoscopy. If the colon is not properly cleaned, those doing colonoscopy may miss important findings such as small polyps. Inadequate preparation of the intestines and the patient's incredible desires will be cancelled and efficient use of resources.

Choose recommendations and important concepts

Choice of preparation, administration and timing, and dietary restrictions

• According to the MSTFCRC, the choice of intestinal preparation regimens, including purgatory, should take into account the patient's preferences, comorbidities, safety, additional costs associated with both prescription and over-the-counter purgatory and adjuvants, and the ease with which patients acquire and consume purgatory or appendages.

• The authors recommend choosing intestinal preparation regimens that consider the individual's medical history, drug therapy, and, where available, validity of intestinal preparation reported from previous colonoscopy.

• Timing of intestinal preparation doses affects the validity of intestinal purification depending on the time of colonoscopy. The authors write that “splitting the doses of bowel preparation agents the night before and morning of colonoscopy and using a 2-liter regimen is sufficient for a morning colonoscopy, while a same-day regimen is an acceptable alternative for outpatients at low risk for inadequate bowel prep undergoing afternoon colonoscopy. A same-day regimen is recommended as an acceptable alternative for individuals undergoing afternoon colonoscopy, but we suggest that a Same day regimen is an inferior alternative for individuals undergoing morning colonoscopy.”

• The authors recommend that individuals using split dosing regimen consume a second portion of intestinal preparations 4-6 hours prior to colonoscopy time and complete preparation at least 2 hours before treatment begins.

• Recommendations for dietary modification depend on the patient's risk for inadequate intestinal preparation. For outpatients with low risk of inadequate intestinal preparation, the authors recommend limiting dietary restrictions the day before colonoscopy, which relies on either clear liquids or low fiber/low-leside diets. The authors provide a table of dietary low-resided foods and samples reported in the scientific literature.

• The authors do not believe that one intestinal preparation is superior to the others, but this document contains a table of characteristics of commonly used PREP regimens, including side effects and contraindications.

Evaluation of intestinal preparation

• MSTFCRC recommends that you address the intestinal preparation quality documentation in endoscopic reports and assess the quality after all washing and aspiration is complete, using a well-understood descriptor that communicates the validity of the preparation.

• The authors recommend using the term “appropriate intestinal preparation” to indicate that standard screening or monitoring intervals can be assigned based on colonoscopy results.

Post-Coronosco inspection: Validity as a quality measure

• MSTFCRC recommends periodically tracking the appropriate intestinal formulation speed at targets above 90% at both rates at individual endoscope level and endoscope unit level.

sauce: US Congregational Social Task Force on Colorectal Cancer Optimization of Intestinal Preparation Quality for Colonoscopy: Consensus Recommendations by the US Multisocial Task Force on Colorectal Cancer

Brian C. Jacobson, MD, MPH, FACG, Agaf, Fudge. Joseph C. Anderson, MD, FACG; Carroll A. Burke, MD, Macg, Agaf, Fasge; Jason A. Dominitz, MD, MHS, FACG, Agaf, Masge; Seth A. Gross, MD, FACG, Agaf, Fasge; Folasade P. May, MD, PhD, Mphil, Agaf; Swati G. Patel, MD, MS; Aasma Shaukat, MD, MPH, FACG, Agaf, Fasge; Douglas J. Robertson, MD, MPH, Agaf.