Boston University Medical Center, 85 East Concord Street, Room 7721, Boston, MA, 02118, USA.
Dig Dis Sci. 2014 Aug;59(8):1726-32. doi: 10.1007/s10620-014-3262-8. Epub 2014 Jul 2.
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.
To examine the degree of variability in colonoscopy instructions across the USA.
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.
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).
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.
接受结肠镜检查的患者通常会获得准备说明。但是，这些说明并未针对肠泻剂类型、饮食限制或管理处方和非处方药物进行标准化。
检查美国各地结肠镜检查说明的变化程度。
从成功参加美国胃肠内镜学会内镜单位认可计划（EURP）的内镜单位收集结肠镜准备说明。使用描述性统计数据描述肠准备、饮食限制、药物说明和其他患者建议方面的差异。
EURP 单位中有 201 个（49%）提供了准备说明。82%的实践采用了分次服用泻剂，但 79 个单位（39%）提供了单剂量和分次剂量方案的说明，18%的单位仅依赖单剂量方案。91%的实践要求患者在结肠镜检查前一天食用清淡液体饮食，但其他具体饮食限制（如避免坚果或豆类）则有所不同。抗血栓和抗血小板药物、非甾体抗炎药和糖尿病药物管理的说明在实践中差异很大。还观察到了不同地区的说明差异。与东北地区的单位相比，西部地区的单位更有可能仅依赖分次准备（p = 0.05），而南部地区的单位不太可能包括华法林管理说明（p < 0.02）。与东北地区相比，美国各地的单位更不可能具体建议继续使用阿司匹林（p < 0.02）。
尽管国家建议使用分次服用肠泻剂，但许多实践仍依赖于单剂量制剂。尽管缺乏支持如此严格饮食方案的必要性的数据，但仍广泛建议在结肠镜检查前一天食用清淡液体饮食。患者在药物管理方面收到的说明差异很大。这些发现表明需要更基于证据和更全面的结肠镜检查准备说明。
