Intraprocedural cleansing work during colonoscopy and achievable rates of adequate preparation in an open-access endoscopy unit.

BACKGROUND

Rates of adequate bowel preparation in the 60% to 80% range continue to be reported for colonoscopy.

OBJECTIVE

To describe the rate of adequate bowel preparation and intraprocedural work needed to achieve this rate in an open-access endoscopy unit. Universal split dosing and regimens tailored to medical predictors of inadequate preparation were used.

DESIGN

Prospective observational study.

SETTING

Academic hospital outpatient endoscopy unit and ambulatory surgery center.

PATIENTS

Outpatients undergoing colonoscopy.

INTERVENTIONS

Prospective assessment of preparation quality for colonoscopy during insertion and after intraprocedural cleansing in 525 patients.

MAIN OUTCOME MEASUREMENTS

Rates of adequate preparation and work required to improve cleansing quality. Work time for cleaning was measured with a stopwatch.

RESULTS

Adequate preparation to allow recommendation of standard screening or surveillance intervals was achieved in 96% of patients, including 6% for whom preparation was adequate only after intraprocedural cleansing work. The mean time for intraprocedural cleaning was 4.1 minutes and constituted 17% of total procedure time. Work time for cleaning and fluid volume injected increased when worse preparation grades were identified before cleaning.

LIMITATIONS

Single-center study with low percentage (4%) of patients receiving Medicaid.

CONCLUSION

An open-access unit using split-dose bowel cleansing preparations can achieve high rates of adequate bowel preparation for colonoscopy. Intraprocedural cleansing accounts for a substantial fraction of the total procedure time in colonoscopy and is an important contributor to high rates of adequate preparation.