Bowel Preparation Regimens

Danielle Goodrich, MSIV

University of Maryland School of Medicine
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Overview
• Colorectal Cancer
• Bowel Preparation Regimens
• Survey
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Colorectal Cancer
• Third most common cancer
• Second leading cause of cancer-related deaths
• Screening colonoscopy has been shown to
reduce mortality
▫ U.S Preventive Services Task Force recommends
Colorectal Cancer Screening for those aged 50
years and above with average risk

USPSTF 2009
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Adequacy of Colonoscopy Depends on Prep

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Adequacy of Colonoscopy
• Up to 25% of patients undergoing colonoscopy
have poor bowel preparation
▫ Lowers the detection of small polyps (<9mm)
▫ Increased risk of procedural complications
▫ Decreased completion rates
▫ Increases the time the endoscopist takes to try to
suction and clean the colon

Van Dongen 2011

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Liquid coming from the bowel

before colonoscopy should look
like….
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Different Dosing Regimens

Split-Dose

Same Day

Traditional

Time of day
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Split-Dose
• Superior to full-dose PEG with respect to
▫ Colon Cleansing
▫ Patient compliance
▫ Patient’s willingness to repeat the same bowel
preparation
▫ Nausea

Kilgore et al 2011
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Survey of Local CRF Programs in Maryland

• 13 questions aimed to identify practice habits of
endoscopists involved in the program

• Program managers in each county of Maryland

who work directly with endoscopists through the
statewide Cigarette Restitution Fund Colorectal
Cancer Screening Program
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Survey Results: Client Education

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Survey Results: Supplier of the

Preparations
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Survey Results: Bowel Preparations

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Survey Results: Bowel Preparations

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Survey Results
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Results Cont’d
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Conclusions
• Physicians are implementing split dose regimens
into their practice.

• Physicians are using different bowel preps for

different patients, suggesting they are taking
into account the patients past medical history
and ability to complete the various regimens.
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Conclusion
• The literature suggests that split-dose regimens:
▫ Improve quality of the study
▫ Reduce cost and complications
▫ Are more favorable to the patient
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Information for the screening programs:

• Please encourage your providers to use split-
dosing regimens if not using split dose currently
• Please disseminate our “Information to the
Provider” handout to the endoscopists in your
program
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Acknowledgements
• Many thanks to the program managers in the
Cigarette Restitution Fund colorectal cancer
screening program at the local health
departments in Maryland who collected and
submitted the data for this survey
• Maryland DHMH Center for Cancer Prevention
and Control
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References
• Monica Van Dongen. Enhancing Bowel Preparation for Colonoscopy.
Gastroenterology Nursing (2012) 35;36-44.
• Dwyer DM et al. Experience of a public health colorectal cancer testing
program in Maryland. Public Health Reports (2012)127:330-339.
• Unger RZ et al. Willingness to Undergo Split-Dose Bowel Preparation for
Colonoscopy and Compliance with Split-Dose Instructions. Dig Dis Sci (2010)
55:2030-2034.
• Di Palma J and Rex D. Advances in Bowel Preparations. Gastroenterology
Nursing (2011) 55:S2-S8
• Kilgore et al. Bowel Preparation with split-dose polyethylene glycol before
colonoscopy: a meta-analysis of randomized controlled trials.
Gastrointestinal Endoscopy (2011) 73:1240-1245.
• Longcroft-Wheaton G and Bhandari P. Same-Day Bowel Cleansing Regimen
is Superior to a Split-Dose Regimen over Two Days for Afternoon
Colonoscopy. J Clin Gastroenterol (2012)46:57-61