Colon Cleansing is Important for High-Quality Colonoscopy

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According to the Center for Digestive Medicine, colon cleansing is important for a high-quality colonoscopy.

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A successful colonoscopy is closely linked to adequate bowel preparation, with poor bowel preparation often resulting in missed precancerous lesions, according to new consensus guidelines released by the U.S. Multi-Society Task on Colorectal Cancer and the Center for Digestive Medicine. Additionally, poor bowel cleansing can result in increased costs related to early repeat procedures. Up to 20 to 25 percent of all colonoscopies are reported to have an inadequate bowel preparation.

“When prescribing bowel preparation for their patients, health-care professionals need to be aware of medical factors that increase the risk of inadequate preparation, as well as non medical factors that may predict poor compliance with instructions,” according to Mark Avila, M.D., gastroenterologist, and co-director of Center for Digestive Medicine. “Gastroenterologists should use this information when determining whether to use a more effective or aggressive bowel preparation regimen, as well as the level of patient education needed about the preparation.”

Adequate Preparation:

  • Adequate preparation is defined as sufficient to allow detection of polyps greater than 5 mm.
  • Such level of cleansing allows for screening and surveillance interval recommendations that comply with guideline intervals appropriate to the findings of the examination. Effect of inadequate preparation on polyp/adenoma detection and recommended follow-up intervals
  • Preliminary assessment of preparation quality should be made. If the indication is screening or surveillance and the preparation is inadequate to allow polyp detection greater than 5 mm, the procedure should be either terminated and rescheduled, or an attempt should be made at additional bowel cleansing strategies that can be delivered without cancelling the procedure that day.
  • If the colonoscopy is complete to the cecum, and the preparation ultimately is deemed inadequate, then the examination should be repeated, generally with a more aggressive preparation regimen, within one year; intervals shorter than one year are indicated when advanced neoplasia is detected and there is inadequate preparation.
  • If the preparation is deemed adequate and the colonoscopy is completed, then the guideline recommendations for screening or surveillance should be followed.

Dosing and timing of colon cleansing regimens

  • Use of a split-dose bowel cleansing regimen is strongly recommended for elective colonoscopy, meaning roughly half of the bowel cleansing dose is given the day of the colonoscopy.
  • The second dose of split preparation ideally should begin four to six hours before the time of colonoscopy with completion of the last dose at least two hours before the procedure time. Usefulness of patient education and navigators for optimizing preparation results.
  • Health-care professionals should provide both oral and written patient education instructions for all components of the colonoscopy preparation and emphasize the importance of compliance.
  • The physician performing the colonoscopy should ensure that appropriate support and process measures are in place for patients to achieve adequate colonoscopy preparation quality.

About: The Center for Digestive Medicine is a premier gastroenterology and Hepatology (liver disease) practice serving the Miami-Dade, Florida area that comprises 3 physicians and 3 ARNP’s with a clinic and an Office-based endoscopy center within the same location for your convenience. Our providers utilize the most advanced equipment, current techniques, and medications to treat all aspects of gastroenterology related diseases including but not limited to: colon cancer screening, treatment of disease of the liver and pancreas, management of GERD, inflammatory bowel syndromes such as Crohn's and ulcerative colitis, and irritable bowel syndrome.

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