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Dolovich C, Unruh C, Moffatt DC, Loewen C, Kaita B, Barkun AN, Martel M, Singh H. Mandatory vs. optional split-dose bowel preparation for morning colonoscopies: a pragmatic noninferiority randomized controlled trial. Endoscopy 2023; 55:822-835. [PMID: 37023789 DOI: 10.1055/a-2070-5561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND : We compared the effectiveness of optional split-dose bowel preparation (SDBP) with mandatory SDBP for morning colonoscopies in usual clinical practice. METHODS : Adult patients undergoing outpatient early morning (8:00 AM-10:30 PM) and late morning (10:30 AM-12:00 PM) colonoscopies were included. Written bowel preparation instructions were provided based on randomization: one group were instructed to take their bowel preparation (4 L polyethylene glycol solution) as a split dose (mandatory), while the comparator group was allowed the choice of SDBP or single-dose bowel preparation administered entirely on the day before (optional). The primary end point, using noninferiority hypothesis testing with a 5 % margin, was adequate bowel cleanliness measured by the Boston Bowel Preparation Scale (BBPS) and defined by a BBPS score ≥ 6. RESULTS : Among 770 randomized patients with complete data, there were 267 mandatory SDBP and 265 optional SDBP patients for early morning colonoscopies, and 120 mandatory SDBP and 118 optional SDBP patients for late morning colonoscopies. Optional SDBP was inferior to mandatory SDBP, with a lower proportion of adequate BBPS cleanliness for early morning colonoscopies (78.9 % vs. 89.9 %; absolute risk difference [aRD] 11.0 %, 95 %CI 5.9 % to 16.1 %), but was not statistically different for late morning colonoscopies (76.3 % vs. 83.3 %; aRD 7.1 %, 95 %CI -1.5 % to 15.5 %). CONCLUSIONS : Optional SDBP is inferior to mandatory SDBP in providing adequate bowel preparation quality for early morning colonoscopies (8:00 AM-10:30 AM), and probably inferior for late morning colonoscopies (10:30 AM-12:00 PM).
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Affiliation(s)
- Casandra Dolovich
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Claire Unruh
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dana C Moffatt
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carrie Loewen
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brennan Kaita
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
- Department of Clinical Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Myriam Martel
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | - Harminder Singh
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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2
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Ma G, Fang X. The safety and effects of high- and low-volume polyethylene glycol bowel preparation methods before colonoscopy on bowel cleanliness: a systematic review and meta-analysis. J Gastrointest Oncol 2023; 14:1759-1769. [PMID: 37720457 PMCID: PMC10502556 DOI: 10.21037/jgo-23-581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/18/2023] [Indexed: 09/19/2023] Open
Abstract
Background Although both high- and low-volume polyethylene glycol (PEG) are widely used in intestinal preparation before colonoscopy, there is still controversy over the superiority of their cleaning effects. This meta-analysis sought to explore the safety and effects of high-volume PEG solution and low-volume PEG mixed solution on intestinal cleanliness before colonoscopy. Methods The PubMed, EMBASE, and Cochrane Library databases were searched to retrieve relevant articles on the effects of high- and low-volume PEG mixture solutions on intestinal cleanliness from the inception of the databases to October 15, 2022. Two independent researchers screened the literature according to the predetermined inclusion and exclusion criteria, and extracted the required data separately. A bias risk assessment was conducted for each study using the relevant tools in the Cochrane Handbook. The included data were subjected to a meta-analysis using R 4.2.1 software. Results This article includes a total of 15 studies involving a total of 5,847 patients. There was no difference in the cleanliness score, qualified rate of intestinal cleanliness and patient compliance between the high- and low-volume group. The patients in the low-volume PEG mixed solution group had a higher repeat willingness bowel cleansing rate than those in the high-volume PEG group [risk ratio (RR) =0.71, 95% confidence interval (CI): 0.62-0.82, P<0.01]. Compared with the low-volume group, the incidence of adverse reactions such as nausea, vomiting, and abdominal pain increased in the high-volume group (RR =1.38, 95% CI: 1.22-1.56, P<0.01; RR =1.79, 95% CI: 1.41-2.27, P<0.01; RR =1.05, 95% CI: 1.01-1.08, P<0.01). Conclusions In the pre-colonoscopy preparation method for patients, although the high-volume PEG and low-volume PEG mixed regimen have similar effects on intestinal cleanliness, the low-volume mixed regimen has a higher willingness to repeat and a lower incidence of adverse reactions. In clinical practice, considering patient compliance and safety, a low-volume mixed regimen may be a more optimal option.
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Affiliation(s)
- Guangting Ma
- Digestive Department, Zhejiang Hospital, Hangzhou, China
| | - Xiaojuan Fang
- Digestive Department, Zhejiang Hospital, Hangzhou, China
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Singh GK, Chauhan SG, Lad SS, Sethiya PR, Gattani MG, Walke S, Shah M, Pandey VR, Ingle MA. Addition of Prucalopride to Standard Bowel Preparation Does Not Improve Colonic Mucosa Visualization—A Retrospective Observational Cohort Study. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1744483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Background Colonoscopy is currently gold standard for visualizing colonic mucosa. Presence of constipation is generally associated with poor bowel preparation. We compared effect on colonic cleansing when prucalopride was used as adjunct with polyethylene glycol (PEG) in patients of constipation.
Methods A retrospective study was conducted at our center. One 70 patients with constipation were enrolled in two groups of who took only PEG and other of prucalopride plus PEG+ for bowel preparation. They underwent colonoscopy by a single-blinded experienced endoscopist. Bowel preparation quality was reported by Boston bowel preparation scale prior to washing or suctioning. The groups were analyzed for bowel preparation quality and side effects in either groups based on preformed questionnaire.
Results Mean Boston Stool preparation Score (BSS) in PEG group (5.33 ± 1.43) was slightly higher than PEG+ (5.16 + 1.37) (p-value =0.44). The total number of patients with side effects was higher in PEG+ group than PEG group. (p < 0.05).
Conclusion We conclude addition of prucalopride has no additional benefit when added with standard bowel preparation in patients of constipation. It may rather lead to noncompliance and inferior bowel preparation due to increased side effects.
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Affiliation(s)
- Gaurav Kr Singh
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | - Shamshersingh G. Chauhan
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | - Saiprasad S. Lad
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | - Pratik R. Sethiya
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | - Mayur G. Gattani
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | - Swapnil Walke
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | - Mit Shah
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | - Vikas R. Pandey
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | - Meghraj A. Ingle
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
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Shimada M, Hirashima N, Iwase H, Saito M, Kondo H, Urata N, Unita S, Kondo T, Tanaka D, Tsunekawa T, Nakamura S, Nishikura M, Miyazawa K, Fukuhara K, Fujishiro M. Evaluating patient acceptability and bowel preparation efficacy of sodium picosulfate‐magnesium citrate for colonoscopy. DEN OPEN 2022; 2:e59. [PMID: 35310719 PMCID: PMC8828216 DOI: 10.1002/deo2.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 11/12/2022]
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Masaaki Shimada
- Department of Gastroenterology National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Noboru Hirashima
- Department of Gastroenterology National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Hiroaki Iwase
- Department of Gastroenterology National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Masashi Saito
- Department of Gastroenterology National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Hisashi Kondo
- Department of Gastroenterology National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Noboru Urata
- Department of Gastroenterology National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Satoshi Unita
- Department of Gastroenterology National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Takashi Kondo
- Department of Gastroenterology National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Daiki Tanaka
- Department of Gastroenterology National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Takuya Tsunekawa
- Department of Gastroenterology National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Sumie Nakamura
- Department of Nursing National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Miho Nishikura
- Department of Nursing National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Kaori Miyazawa
- Department of Nursing National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Kiyoko Fukuhara
- Department of Nursing National Hospital Organization, Nagoya Medical Center Aichi Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology Graduate School of Medicine, The University of Tokyo Tokyo Japan
- Department of Gastroenterology & Hepatology Nagoya University Graduate School of Medicine Aichi Japan
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van Riswijk MLM, van Keulen KE, Siersema PD. Efficacy of ultra-low volume (≤1 L) bowel preparation fluids: Systematic review and meta-analysis. Dig Endosc 2022; 34:13-32. [PMID: 33991373 PMCID: PMC9290948 DOI: 10.1111/den.14015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS High-quality bowel preparation is paramount for the diagnostic accuracy and safety of colonoscopy; however, it is often difficult for patients to adhere to high-volume laxatives, which may contribute to poor bowel preparation. This review aims to assess the efficacy of bowel preparation fluids of 1 L or less (≤1 L). METHODS We performed a systematic review including all relevant randomized controlled trials on ultra-low volume (≤1 L) bowel preparation fluids for colonoscopy published since 2015. Primary endpoint was the percentage of adequately prepared patients. Secondary endpoints included adenoma detection rate (ADR) and safety. RESULTS Bowel preparation with sodium picosulfate/magnesium citrate (SPMC; 19 trials, n = 10,287), 1L-polyethylene glycol with ascorbate (PEGA; 10 trials, n = 1717), sodium phosphate (NaP; 2 trials, n = 621), and oral sulfate solution (OSS; 3 trials, n = 597) was adequate in 75.2%, 82.9%, 81.9%, and 92.1%, respectively, of patients; however, heterogeneity between studies was considerable (I2 range: 86-98%). Pooled ADRs were 31.1% with SPMC, 32.3% with 1L-PEGA, 30.4% with NaP, and 40.9% with OSS. Temporary electrolyte changes were seen with all ultra-low volume bowel preparation fluid solutions but without sustained effects in most patients. CONCLUSION Ultra-low volume bowel preparation fluids do not always meet the 90% quality standard for adequate bowel preparation as defined by current guidelines. Nonetheless, they may be considered in patients intolerant for higher-volume laxatives and without risk factors for inadequate bowel preparation or dehydration-related complications.
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Affiliation(s)
- Milou L. M. van Riswijk
- Department of Gastroenterology and HepatologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - Kelly E. van Keulen
- Department of Gastroenterology and HepatologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - Peter D. Siersema
- Department of Gastroenterology and HepatologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
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Tontini GE, Prada A, Sferrazza S, Ciprandi G, Vecchi M. The unmet needs for identifying the ideal bowel preparation. JGH OPEN 2021; 5:1135-1141. [PMID: 34621998 PMCID: PMC8485412 DOI: 10.1002/jgh3.12653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/21/2021] [Indexed: 12/23/2022]
Abstract
Colonoscopy, since it was first employed over 60 years ago, is now the gold standard method for visualizing the mucosa of the colon, but should be of good quality. Many factors affect quality, including the type of health service organization, type of facility, staff, equipment, patient characteristics, and bowel preparation (BP). The adequacy of bowel cleansing is critical, but, unfortunately, may be inadequate in up to one‐third of procedures. The current article will present and discuss the main BPs and their drawbacks, which include patient‐dependent and procedure‐dependent factors. Cleansing quality depends on the ease/complexity of solution preparation, volume, taste, and timing of consumption. Consequently, important positive factors include simple instructions, easy preparation of the solution, low volume, pleasant taste, short drinking time (e.g. <30 min), and splitting the dose between the evening before and the morning of the colonoscopy (or even better, only one dose in the early morning to avoid night‐time problems), and short onset of action. The BP solution must also be safe with negligible side effects. Furthermore, a positive experience supports patient willingness to repeat the procedure.
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Affiliation(s)
- Gian E Tontini
- Department of Internal Medicine Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Alberto Prada
- Digestive Endoscopy Istituto Auxologico Italiano Milan Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Area Chirurgia Specialistica Santa Chiara Hospital Trento Italy
| | - Giorgio Ciprandi
- Outpatient Department, Casa di Cura Villa Montallegro Genoa Italy
| | - Maurizio Vecchi
- Department of Internal Medicine Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
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7
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Al Alawi S, Al Dhahab H, Al Salmi I. Split dose bowel preparation before colonoscopy of PEG (Nulytely) in comparison to routine single dose bowel preparation. Saudi J Gastroenterol 2021; 27:234-239. [PMID: 34380867 PMCID: PMC8448009 DOI: 10.4103/sjg.sjg_563_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to compare the efficacy and tolerability of polyethylene glycol (PEG) in single- or split-dose regimens for colonoscopy bowel preparation. METHODS This is a prospective, randomized, endoscopist blinded, single-center study, that included adult patients who underwent colonoscopy during the period from December 2017 to October 2018. Two groups were enrolled in the same period: One group used 4 L of PEG (Nulytely) in a single-dose preparation, administered a day before the procedure, and the other group received a split-dose regimen of 2 L PEG (Nulytely), given a day before the procedure and 2 L on the day of the procedure in the early morning. The Boston Bowel Preparation Scale (BBPS) was used for bowel preparation adequacy; scales 0 and 1 were considered inadequate, and scales 2 and 3 were considered adequate preparation. RESULTS Two hundred and forty patients were enrolled, 120 (50%) using the split-dose regimen and 120 (50%) using the single-dose regimen, for bowel preparation. Males constituted 51.6% of the study cohort. In the single-dose group, 62.5% achieved adequate bowel preparation compared to 89.2% in the split-dose group (p< 0.001). In addition, polyp detection in the split-dose group was 23.3% in comparison to 10.8% in the single-dose group (P = 0.016). We also found hypertension and diabetes as significant predictors of bowel preparation inadequacy, while sex and age were not related to bowel preparation adequacy. CONCLUSIONS Split-dose bowel preparation for colonoscopy with PEG (Nulytely) is better than routine single-dose, in terms of adequate bowel preparation and polyp detection.
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Affiliation(s)
- Said Al Alawi
- Internal Medicine Department, Oman Medical Specialty Board, Muscat, Oman
- Department of Gastroenterology, The Royal Hospital, Muscat, Oman
| | - Hisham Al Dhahab
- Department of Gastroenterology, The Royal Hospital, Muscat, Oman
| | - Issa Al Salmi
- Internal Medicine Department, Oman Medical Specialty Board, Muscat, Oman
- Department of Medicine, The Royal Hospital, Muscat, Oman
- Address for correspondence: Dr. Issa Al Salmi, The Royal Hospital, 23 July Street, P. O. Box 1331, Code 111, Muscat, Oman. E-mail:
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de Miranda Neto AA, de Moura DTH, Hathorn KE, Tustumi F, de Moura EGH, Ribeiro IB. Efficacy and Patient Tolerability of Split-Dose Sodium Picosulfate/Magnesium Citrate (SPMC) Oral Solution Compared to the Polyethylene Glycol (PEG) Solution for Bowel Preparation in Outpatient Colonoscopy: An Evidence-Based Review. Clin Exp Gastroenterol 2020; 13:449-457. [PMID: 33116741 PMCID: PMC7548852 DOI: 10.2147/ceg.s237649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022] Open
Abstract
Background Colonoscopy is the gold standard exam for evaluation of colonic abnormalities and for screening and surveillance for colorectal cancer. However, the efficacy of colonoscopy is dependent on the quality of the pre-colonoscopy bowel preparation. Polyethylene glycol (PEG) and sodium picosulfate/magnesium citrate (SPMC) have emerged as two of the most commonly used bowel preparation agents. We conducted an evidence-based review of current evidence to further investigate the efficacy and patient tolerability of split-dose SPMC oral solution compared to PEG solution for colonoscopy bowel preparation. Methods A systematic search was performed using Pubmed (MEDLINE), Web of Science, EMBASE, and Cochran Central Register of Controlled Trials databases. All studies on split-dose bowel preparation with SPMC and PEG were reviewed. Relevant studies regarding colonoscopy and bowel preparations were also included. Randomized controlled trials were prioritized due to the high quality of evidence. Results Eight randomized controlled trials were included. Split-dose SPMC and PEG were associated with similar results for adequacy of bowel preparation. Split-dose SPMC was associated with increased patient tolerability and compliance. Conclusion Split-dose SPMC and PEG are both adequate and safe for bowel preparation for outpatient colonoscopy, with split-dose SPMC being more tolerable for patients. Additional RCTs comparing these and other bowel preparation solutions are necessary to further investigate quality of bowel preparation, patient preference, and cost-effectiveness of the various options.
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Affiliation(s)
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Hospital Das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.,Division of Gasteoenterology, Hepatology and Endoscopy - Brigham and Women´s Hospital - Harvard Medical School, Boston, MA, USA
| | - Kelly E Hathorn
- Division of Gasteoenterology, Hepatology and Endoscopy - Brigham and Women´s Hospital - Harvard Medical School, Boston, MA, USA
| | - Francisco Tustumi
- Gastrointestinal Surgery Unit, Hospital Das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital Das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
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Millien VO, Mansour NM. Bowel Preparation for Colonoscopy in 2020: A Look at the Past, Present, and Future. Curr Gastroenterol Rep 2020; 22:28. [PMID: 32377915 DOI: 10.1007/s11894-020-00764-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF THIS REVIEW Colorectal cancer is the third most common cancer in the USA. Colonoscopy is considered the gold standard for colorectal cancer screening and can offer both diagnosis and therapy. The bowel preparation remains a significant barrier for patients who need to undergo colonoscopy and is often cited as the most dreaded aspect of the colonoscopy process. Inadequate bowel preparations still occur in 10-25% of colonoscopies, and this in turn can lead to increased procedural times, lower cecal intubation rates, and shorter interval between colonoscopies. From a quality standpoint, it is imperative that we do what we can to decrease the rate of inadequate bowel preparations. This review will focus on recent data regarding bowel preparation and offers a glimpse into what may be coming in the future. RECENT FINDINGS Recent advances in the field have been made to improve tolerability of bowel preparations and allow for more adequate colonoscopies. Newer, lower volume, flavored preparations, the use of adjuncts, and using split-dose preparations all can help with tolerability, compliance, and, in turn, preparation quality. Edible bowel preparations may become available in the near future. Early data on the use of artificial intelligence for assessment of preparation quality has been promising. Additionally, utilization of smartphone technology for education prior to the bowel preparation has also been shown to improve the adequacy of bowel preparations. CONCLUSIONS Ongoing efforts to improve the tolerability and palatability of colonoscopy bowel preparations are important from a quality improvement standpoint to ensure the adequacy of colonoscopy. Incorporating patient-specific factors and comorbidities is also an essential aspect of improving the quality of bowel preparation. Leveraging technology to better communicate with and educate patients on the bowel preparation process is likely to play a larger role in the coming years.
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Affiliation(s)
- Valentine Ongeri Millien
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, 7200 Cambridge St., Suite 8B, Houston, TX, 77030, USA
| | - Nabil M Mansour
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, 7200 Cambridge St., Suite 8B, Houston, TX, 77030, USA.
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