Bowel Prep for Colonoscopy: Quality Matters скачать в хорошем качестве

Bowel Prep for Colonoscopy: Quality Matters

Dr David Johnson provides highlights from the US Multi-Society Task Force on Colorectal Cancer’s latest consensus recommendations. https://www.medscape.com/viewarticle/... -- TRANSCRIPT -- Hello. I’m Dr David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School and Old Dominion University in Norfolk, Virginia. Welcome back to another GI Common Concerns. Today, I wanted to highlight important new consensus recommendations from the US Multi-Society Task Force on Colorectal Cancer around colonoscopy preparation. The message behind them is clear: Quality matters. The new threshold for the rate of adequate bowel preparation for both individual endoscopists and endoscopy units is now 90%. Having led the US Multi-Society Task Force in 2014, I feel particularly privileged to offer my comments and insights around this group’s latest brilliant work. So, let’s get into what they’ve recommended and provide you with some valuable take-home messages. Bowel Prep Is Critical When we talk about quality in colonoscopy, we’re referring to adenoma detection and sessile serrated lesion detection, along with the associated documentation that we perform. In September 2024, the American College of Gastroenterology (ACG) and American Society for Gastrointestinal Endoscopy (ASGE) put out new recommendations on quality indicators for colonoscopy. In that, they explicitly recommend a performance target of 90% for adequacy of colon preparations. Achieving that level of quality is not just about writing a prescription for the prep and instructing your patients to follow through with it. Rather, it means providing guidance around diet modification and medication management and explaining the importance of the prep and how it is integral to colonoscopy performance. It’s a shared responsibility. You, as well as your staff, need to take the time to discuss it with your patients. The adequacy of the preparation is central to achieving the best outcome. Our goal is to prevent cancer by detecting and removing polyps and/or finding high-risk lesions for diagnostic study. Dosing and Diet The standard of care for colonoscopy prep remains the same as in the prior recommendation: split dosing. There’s one exception for same-day colonoscopy. If you have an afternoon colonoscopy, split dosing is fine, but a same-day regimen is an acceptable alternative. However, if you have a morning colonoscopy, the experts suggest that we stick to split dosing, as it remains the standard. Prep volumes are becoming more central to ensuring patient compliance, as they’re more willing to take lower volumes. The task force separated volume into three different categories: high volume ( 4 L), low volume (2-4 L), or ultra-low volume (1 L). They noted that patients prefer the ease of taking a lower-volume prep. However, trial results around ultra-low-volume prep have shown a lot of heterogeneity, which is why it was not recommended by these experts. Remind patients that “volume” refers to that of the prep itself and doesn’t include any additional liquids they need to consume to compensate. If they tell you they can’t drink that much, they still have to hit the target of the prep volume. The use of patient navigation tools to help prepare patients for colonoscopy has expanded considerably since we published the last recommendations in 2014. There is now telephonic or automated electronic messaging as well as virtual navigation tools that we can use to improve our patients’ understanding and compliance, including with dietary measures. We should all be aware of these adjunctive tools, which the recommendations strongly suggest that we employ. The recommendation to include low-residue or low-fiber foods the day of colonoscopy was put forward in 2014. I think it’s been misunderstood for a lot of reasons, one of which is a lack of standardization about what a low-residue diet means. Kudos to the authors of these consensus recommendations, who provided a table of low-residue foods and sample meals, which can easily be incorporated into your own electronic medical records or handouts. If your patient doesn’t meet the criteria for predictors of inadequate prep, then they should be allowed to at least have some of these foods for breakfast and even for a noon meal. Your patients are perhaps best guided in these efforts by giving them this list of food options. Transcript in its entirety can be found by clicking here: https://www.medscape.com/viewarticle/...