Home E-Weekly October 28, 2014

New Colonoscopy Prepping Guidelines Released

Published: October 27, 2014

Split-dosing is the standard of care in colonoscopy bowel prepping, according to new multi-society guidelines, which also raise expectations for ensuring that patients present for screenings with adequate preps in place.

A committee of representatives from the American Gastroenterological Association, American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy jointly published the guidelines in the October issues of the American Journal of Gastroenterology, Gastrointestinal Endoscopy, and Gastroenterology.

The first dose should be taken the evening before the procedure, he explains, and the second the morning of the screening, beginning 4 to 6 hours before the colonoscopy start time and completed within 2 hours of the exam.

"The committee stated overwhelmingly that split-prepping is the standard of care and should be done routinely," says David Johnson, MD, lead author of the new guidelines and professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk. "Split-dosing leads to a better prep and increases patients' willingness to undergo screening again."

Inadequate preps should be determined very quickly, according to Dr. Johnson. "Aborting the exam is not subject to salvage strategy," he says. "Cancelled exams should be repeated within a year. That's new. A number of studies have suggested 3 years, particularly for patients with adenomas."

The committee also reassessed the definition of successful preps. Dr. Johnson says approximately 75% of preps are adequate, but the new guidelines increase the minimal threshold to 85%. He believes this new measurement will get some traction as the national societies look to new benchmarking technology to measure and evaluate the quality of colonoscopy exams.

Patients need to clearly understand prepping guidelines, the importance of following them and why prepping is so critical to quality exams, says Dr. Johnson, who added that physicians will be expected to maintain the new level of successful in practice.

"Really, successful preps should be achieved more than 85% of the time. Everyone is going to be accountable to that threshold, so be ready," he says. "We frequently hear physicians say patients didn't take the prep. But it's not just the patient's problem."

Daniel Cook

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