• CRC screening
• Endoscopy Lower GI Tract
• Polyps / adenomas / ...
• Preparation
• Quality and logistical aspects

• BBPS
• Colonoscopy
• OSS
• Oral sulfate solution
• PEG
• Split dose bowel preparation

• Humans
• Male
• Colonoscopy/statistics & numerical data
• Colonoscopy/standards
• Colonoscopy/methods
• Alabama/epidemiology
• Middle Aged
• Female
• Retrospective Studies
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/epidemiology
• Aged
• Rural Population/statistics & numerical data
• Early Detection of Cancer/methods
• Adenoma/diagnosis
• Adenoma/epidemiology
• Social Determinants of Health
• Quality of Health Care

• bowel preparation
• endoscopy
• pediatric

• Humans
• Colonoscopy/methods
• Polyethylene Glycols/administration & dosage
• Polyethylene Glycols/adverse effects
• Citrates/administration & dosage
• Citrates/adverse effects
• Cathartics/administration & dosage
• Cathartics/adverse effects
• Picolines/administration & dosage
• Picolines/adverse effects
• Citric Acid/administration & dosage
• Citric Acid/adverse effects
• Child
• Magnesium Oxide/administration & dosage
• Magnesium Oxide/adverse effects
• Organometallic Compounds/administration & dosage
• Organometallic Compounds/adverse effects
• Randomized Controlled Trials as Topic

• None

• CRC screening
• Endoscopy Lower GI Tract
• Preparation
• Quality and logistical aspects
• Quality management

• bowel preparation
• colonoscopy
• electrolyte disorder
• hypokalemia
• low potassium

• Cathartics/adverse effects
• Colonoscopy/adverse effects
• Colonoscopy/methods
• Electrolytes/adverse effects
• Humans
• Hypokalemia
• Polyethylene Glycols/adverse effects
• Potassium

• Ascorbic acid
• Bowel preparation
• Colonoscopy
• Osmolality
• Polyethylene glycol
• Serum electrolytes

Adequate bowel preparation is a prerequisite for effective colonoscopy. Split bowel preparation results in optimal cleansing. This study assessed the bowel preparation regimes advised by endoscopy units across the UK, and correlated the differences with outcomes.

Trusts in the UK were surveyed, with data requested between January 2018 and January 2019, including: the type and timing of preparation, pre-endoscopy diet, adequacy rates and polyp detection. Trusts were grouped according to the timing of bowel preparation. χ² test was used to assess for differences in bowel preparation adequacy.

Moviprep was the first line bowel preparation in 79% of trusts. Only 7% of trusts advised splitting bowel preparation for all procedures, however, 91% used split bowel preparation for afternoon procedures. Trusts that split preparation for all procedures had an inadequacy rate of 6.7%, compared with 8.5% (p<0.001) for those that split preparation for PM procedures alone and 9.5% (p<0.001) for those that provided day before preparation for all procedures. Morning procedures with day-before preparation had a higher rate of inadequate cleansing than afternoon procedures that received split preparation (7.7% vs 6.5 %, p<0.001). The polyp detection rate for procedures with adequate preparation was 37.1%, compared with 26.4% for those that were inadequate.

Most trusts in the UK do not provide instructions optimising the timing of bowel preparation prior to colonoscopy. This correlated with an increased rate of inadequate cleansing. Splitting bowel preparation is likely to reduce the impacts of poor cleansing: missed lesions, repeat colonoscopies and significant costs.

• adenoma
• cancer prevention
• colonic polyps
• colonoscopy
• colorectal cancer

DCL-101, a novel Pill Prep, is compositionally identical to standard 4L polyethylene glycol-electrolyte solution (PEG-ELS) and delivers the salt encapsulated, with PEG 3350 coadministered as a taste-free oral solution. The aim of this study was to compare the safety, taste, and tolerability of DCL-101 with 4L PEG-ELS in outpatients preparing for colonoscopy, with a secondary objective to assess efficacy.

This was a multicenter, randomized, investigator-blinded, phase 2 clinical trial of 45 adult patients undergoing outpatient colonoscopy. Patients were randomized 2:1 to either DCL-101 (3L in cohort 1; 4L in cohort 2) or 4L PEG-ELS, each administered with split dosing. Safety was assessed over 3 post-treatment clinic visits. Tolerability was measured using the Lawrance Bowel-Preparation Tolerability Questionnaire and the Mayo Clinic Bowel Prep Tolerability Questionnaire. Efficacy was determined by expert central readers, blinded to treatment, using the Ottawa Bowel Preparation Quality Scale, Boston Bowel Preparation Scale, and Aronchick scale.

Both DCL-101 doses had superior taste and tolerability relative to 4L PEG-ELS. All adverse events were grade 1 with no significant differences in adverse events among the 3 regimens. There were no significant differences in efficacy among the 3 treatments as defined by the centrally read Ottawa Bowel Preparation Quality Scale, Boston Bowel Preparation Scale, or Aronchick scores. There were no inadequate preps as judged by the site endoscopist.

DCL-101 Pill Prep is a novel strategy that vastly improves the taste and tolerability of PEG-ELS solutions with safety and efficacy comparable with split-dose 4L PEG-ELS solutions.

• bowel preparation
• colonoscopy
• polyethylene glycol
• sennosides

• Abdominal Pain/epidemiology
• Abdominal Pain/etiology
• Adult
• Aged
• Cathartics/administration & dosage
• Cathartics/adverse effects
• Colonoscopy
• Female
• Humans
• Intestinal Diseases/diagnosis
• Intestinal Diseases/epidemiology
• Male
• Middle Aged
• Nausea/epidemiology
• Nausea/etiology
• Patient Compliance/statistics & numerical data
• Polyethylene Glycols/administration & dosage
• Polyethylene Glycols/adverse effects
• Prospective Studies
• Sennosides/administration & dosage
• Sennosides/adverse effects
• Treatment Outcome
• Vomiting/epidemiology
• Vomiting/etiology
• Vomiting/prevention & control

• Bowel preparation
• Colonoscopy
• Functional constipation
• Risk factor

• Anniversaries and Special Events
• Cathartics/standards
• Colonic Neoplasms/prevention & control
• Early Detection of Cancer/standards
• Health Promotion
• Humans

• ascorbic acid
• bowel preparation solutions
• colonoscopy
• low-residue diet
• polyethylene glycol

• adenoma
• adenoma detection rate
• cancer
• colorectal
• detection
• endoscopy
• quality
• rate
• screening
• technology

• Adenoma detection rate
• bowel preparation
• patient satisfaction
• quality assurance
• screening colonoscopy

• Adult
• Aged
• Colonoscopy/methods
• Colonoscopy/standards
• Female
• Humans
• Male
• Middle Aged
• Patient Compliance
• Patient Satisfaction
• Preoperative Care/methods
• Preoperative Care/standards
• Quality Assurance, Health Care
• Surveys and Questionnaires

• Norgine Pharma

• Aronchick scale
• bisacodyl
• colonoscopy preparation
• polyethylene glycol

• Bowel preparation
• Colonoscopy
• Guidelines
• Inadequate bowel preparation

• bowel preparation
• diet
• colonoscopy
• boston bowel preparation scale

The quality of bowel preparation is a major determinant of the quality of colonoscopy. This study evaluated lifestyle factors, including usual dietary style, associated with bowel preparation.

This retrospective study evaluated 1,079 consecutive subjects who underwent complete colonoscopy from December 2012 to April 2014 at National Cancer Center of Korea. Questionnaires on bowel preparation were completed by the subjects, with the quality of bowel preparation categorized as optimal (excellent or good) or suboptimal (fair, poor or inadequate). Lifestyle factors associated with bowel preparation were analyzed.

The 1,079 subjects included 680 male (63.0%) and 399 female patietns (37.0%), with a mean age of 49.6 ± 8.32 years. Bowel preparation was categorized as optimal in 657 subjects (60.9%) and as suboptimal in 422 (39.1%). Univariate analyses showed no differences between groups in lifestyle factors, such as regular exercise, alcohol intake, smoking, and dietary factor. Body mass index (BMI) > 25 kg/m² was the only factor associated with suboptimal bowel preparation on both the univariate (P = 0.007) and the multivariate (odds ratio, 1.437; 95% confidence interval, 1.104–1.871; P = 0.007) analyses.

Most lifestyle factors, including dietary patterns, exercise, alcohol intake and smoking, were not associated with suboptimal bowel preparation in Koreans. However, BMI > 25 kg/m² was independently associated with suboptimal bowel preparation. More intense preparation regimens before colonoscopy can be helpful in subjects with BMI > 25 kg/m².

• Colonoscopy
• Dietary supplements
• Life style
• Quality

• colonoscopy
• bowel preparation
• adenoma

To prospectively assess physician recommendations for repeat colonoscopy in an average-risk screening cohort.

Endoscopists' adherence to colorectal cancer screening and surveillance guidelines for repeat colonoscopy have not been well characterized. Furthermore, little is known about patient and colonoscopy factors that are associated with endoscopists' nonadherence to guideline recommendation.

This is a prospective cohort of average-risk patients undergoing colonoscopy for colorectal cancer screening between August 2011 and January 2013. The primary outcome was assessment of physician recommendations for repeat colonoscopy.

462 participants were prospectively enrolled. 13.6% (62) had guideline-inconsistent recommendations. 89% of the guideline-inconsistent recommendations were for an earlier interval. Endoscopists' reports cited suboptimal bowel preparation as the most common reason for earlier repeat colonoscopy. On multivariable analysis, patient split-dose preparation noncompliance was significantly associated with guideline-inconsistent recommendation (OR = 2.7) even after adjusting for other patient or bowel preparation-related characteristics. Additionally, increased odds of guideline-inconsistent recommendation were associated with older age (>70 years old), higher BMI, having 3 or more polyps, having had at least two previous colonoscopies, suboptimal bowel preparation, and having taken at least 12 hours till clear bowel movement.

Gastroenterologists are adherent to CRC screening and surveillance guidelines. Suboptimal bowel preparation is the most frequently cited factor in endoscopy reports leading to deviation from guidelines. Continued emphasis on optimization of bowel preparation, particularly patient compliance to split-dose regimen, is needed.

• Aged
• Anciano
• Edad avanzada
• Elderly
• Endoscopia
• Endoscopy
• Preparación
• Preparation
• Sedación
• Sedation

• Age Factors
• Aged
• Endoscopy, Gastrointestinal/standards
• Humans
• Preoperative Care
• Risk Assessment

Bowel preparations with polyethylene glycol (PEG) and clear fluids are often poorly tolerated. We compared an innovative low‐residue White Diet and low‐volume, split‐dose Picosalax with the standard preparation at our institution of day‐before clear fluids and combination PEG plus sodium picosulfate/magnesium citrate (SPMC).

Adults undergoing morning colonoscopy were randomized to either the White Diet and split‐dose, two sachets of Picosalax (WD/PICO) or day‐before clear fluids and 1‐L PEG plus two sachets of SPMC (CF/PEG + SPMC). The primary endpoint was successful bowel preparation defined by an Ottawa bowel preparation score ≤ 6. An intention‐to‐treat analysis with a predefined non‐inferiority margin of 15% was used to compare efficacy.

A total of 250 patients were randomized (125 WD/PICO and 125 CF/PEG + SPMC). WD/PICO was non‐inferior to CF/PEG + SPMC for successful bowel preparation by intention‐to‐treat analysis (58% WD/PICO vs 62% CF/PEG + SPMC, 95%CI: −14.2 to 6.2%) and per‐protocol analysis (64% WD/PICO vs 65% CF/PEG + SPMC, 95%CI: −11.3 to 9.4%). Patients in the WD/PICO group reported greater satisfaction with the diet (P < 0.001), greater ease of following the diet (P < 0.001), and improved experience compared with prior colonoscopy (P < 0.0001), less bloating (P = 0.02), less weakness (P = 0.046), less hunger (P < 0.0001), and less interference with daily activities (P = 0.001). Procedure/withdrawal times and adenoma detection rates were similar between groups.

Bowel preparation with the White Diet and low‐volume, split‐dose Picosalax was preferred and better tolerated without detriment to bowel preparation success compared with clear fluids and combination PEG plus SPMC for morning colonoscopy.

• adenoma
• bowel preparation
• colonoscopy

Variation exists among anesthesia providers as to acceptable timing of NPO (“nothing by mouth”) for elective colonoscopy procedures. There is a need to balance optimal colonic preparation, patient convenience, and scheduling efficiency with anesthesia safety concerns. We reviewed the evidence for the relationship between NPO timing and aspiration incidence and colonoscopy rescheduling.

We searched MEDLINE (1990–April 2015) for English language studies of any design and included them if at least one bowel preparation regimen was completed within 8 hours of colonoscopy. Study characteristics, patient characteristics, and outcomes were abstracted and verified by investigators. We determined risk of bias for each study and overall strength of evidence for primary and secondary outcomes.

We included 28 randomized controlled trials (RCTs), 2 controlled clinical trials, and 10 observational reports. Six studies reported on aspiration; none found that shorter NPO status prior to colonoscopy increased aspiration risk, though studies were not designed to assess this outcome (low strength of evidence). One RCT found fewer rescheduled procedures following split-dose preparation but NPO status was not well-documented (insufficient evidence).

Aspiration incidence requiring hospitalization during colonoscopy with moderate or deep sedation is very low. No study found that shorter NPO status prior to colonoscopy increased aspiration risk. We did not find direct evidence of the effect of NPO status on colonoscopy rescheduling.

• Colonoscopy/methods
• Diet
• Humans
• Patient Compliance
• Patient Preference
• Preoperative Care/methods

• Colonoscopes
• Colonoscopy
• Pain

Adequate bowel preparation is an essential prerequisite for complete mucosal visualization during colonoscopy. Polyethylene glycol (PEG) solutions are commonly used. However the large volume of the solution is often poorly tolerated. Addition of Lubiprostone (LB) could improve the adequacy of standard PEG preparation & reduce requirement. The aims to assess adequacy of PEG preparation with addition of single dose LB (24mcg) vs placebo and efficacy of reduced dose PEG + LB compared with full dose PEG + LB.

Single center prospective double blind randomized controlled trial. Part I: 442 patients for colonoscopy randomized to receive placebo (GrA) or single dose of LB (GrB) prior to PEG preparation. Quality of bowel preparation graded 0–9 according to Boston Bowel Preparation Scale (BBPS). BBPS-9: excellent and BBPS 0–4: repeat procedure.

Part II: 146 patients randomized to receive LB + 1.5 L PEG (GrC; 75) or LB + 1 L PEG (GrD; 71). BBPS score compared with GrB (2 L PEG).

Part I: 442 patients (221 GrA & 221 Gr B). LB resulted in significant improvement in total BBPS (7.44 + 0.14 vs. 6.36 + 0.16, p < 0.0001). 66.5 % Gr B vs 38 % Gr A had excellent prep; 42.5 % GrB vs 24 % GrA had adequate prep. Repeat procedure needed 9.5 % Gr B vs 16.7 % Gr A (P < 0.01).

Part II: No difference in BBPS scores with lower doses (Gr C&D) compared to standard (GrB) (Mean BBPS 7.44 + 0.14 GrA,7.30 + 0.25 GrC;7.25 + 0.26 GrD;p >0.05).

Single dose LB prior to PEG significantly enhanced bowel preparation compared to PEG alone. There was no significant difference in quality of preparation with lower doses of PEG when combined with LB.

The study protocol was approved by institutional review board and the trial was registered on March 22, 2011 with clinicaltrials.gov (NCT01324284).

• Bowel preparation
• Colonoscopy
• Lubiprostone
• PEG

• ascorbic acid
• chronic kidney disease
• colonoscopy
• polyethylene glycol
• safety

• Aged
• Ascorbic Acid
• Cathartics
• Colonoscopy
• Female
• Humans
• Male
• Middle Aged
• Polyethylene Glycols
• Renal Insufficiency, Chronic
• Retrospective Studies

• Age Factors
• Aged
• Aged, 80 and over
• Case-Control Studies
• Colon, Ascending/pathology
• Colonoscopy
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/epidemiology
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/therapy
• Comorbidity
• Databases, Factual
• Early Detection of Cancer
• Elective Surgical Procedures
• Emergencies
• England/epidemiology
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Sex Factors

• Ascorbic acid
• Bowel preparation
• Colonoscopy
• Mucosal injury
• Polyethylene glycols

• Adult
• Ascorbic Acid/administration & dosage
• Ascorbic Acid/adverse effects
• Cathartics/administration & dosage
• Cathartics/adverse effects
• Colonoscopy/methods
• Drug Therapy, Combination
• Female
• Humans
• Intestinal Mucosa/drug effects
• Intestinal Mucosa/injuries
• Male
• Middle Aged
• Patient Compliance
• Patient Satisfaction
• Polyethylene Glycols/administration & dosage
• Polyethylene Glycols/adverse effects
• Preoperative Care/adverse effects
• Preoperative Care/methods
• Surveys and Questionnaires
• Vitamins/administration & dosage
• Vitamins/adverse effects

• bowel preparation
• colonoscopy
• diet
• low fiber
• low residue

Effective colorectal cancer screening relies on reliable colonoscopy findings which are themselves dependent on adequate bowel cleansing. Research has consistently demonstrated that inadequate bowel preparation adversely affects the adenoma detection rate and leads gastroenterologists to recommend earlier follow up than is consistent with published guidelines. Poor preparation affects as many as 30% of colonoscopies and contributes to an increased cost of colonoscopies. Patient tolerability is strongly affected by the preparation chosen and manner in which it is administered. Poor tolerability is, in turn, associated with lower quality bowel preparations. Recently, several new developments in both agents being used for bowel preparation and in the timing of administration have brought endoscopists closer to achieving the goal of effective, reliable, safe, and tolerable regimens. Historically, large volume preparations given in a single dose were administered to patients in order to achieve adequate bowel cleansing. These were poorly tolerated, and the unpleasant taste of and significant side effects produced by these large volume regimens contributed significantly to patients’ inability to reliably complete the preparation and to a reluctance to repeat the procedure. Smaller volumes, including preparations that are administered as tablets to be consumed with water, given as split doses have significantly improved both the patient experience and efficacy, and an appreciation of the importance of the preparation to colonoscopy interval have produced additional cleansing.

• Bowel preparation
• Colonoscopy
• Adenoma detection rate
• MiraLAX
• Polyethylene glycol
• Sodium picosulfate
• Oral sulfate solution

• Bowel cleansing colonoscopy
• Polyethylene glycol
• Randomized trial
• Same-day bowel preparation
• Sodium picosulfate/magnesium citrate

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cathartics/administration & dosage
• Cathartics/adverse effects
• Citrates/administration & dosage
• Citrates/adverse effects
• Citric Acid/administration & dosage
• Citric Acid/adverse effects
• Colonoscopy/methods
• Drug Administration Schedule
• Female
• Gastrointestinal Diseases/chemically induced
• Humans
• Male
• Middle Aged
• Organometallic Compounds/administration & dosage
• Organometallic Compounds/adverse effects
• Patient Satisfaction
• Picolines/administration & dosage
• Picolines/adverse effects
• Polyethylene Glycols/administration & dosage
• Polyethylene Glycols/adverse effects
• Young Adult

• Bowel preparation
• Colonoscopy
• Efficacy
• Menthol
• Tolerability