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Scheduling rules for patients with diabetes mellitus that facilitate split-dosing improve the quality of bowel preparation for colonoscopy.

ABSTRACT: An adequate bowel preparation for colonoscopy is best achieved by giving the cleansing regimen as a split-dose with the second dose given 4-6 hours before the procedure. This can be difficult to administer to diabetics who are preferentially scheduled for early morning procedures. We examined the impact on bowel preparation quality of scheduling diabetics for mid-morning (9:30 am or later) procedures rather than early morning procedures (7:30-9:00 AM) to facilitate a split-dose preparation.Historical cohort study of 34,415 patients (1,805 diabetics) age 18-74 years without significant comorbidities who underwent an outpatient colorectal cancer screening-related colonoscopy either before (2013) or after (2014) a unit wide change in scheduling practices for diabetics. The primary outcome was the rate of inadequate bowel preparation. Secondary outcomes include the rate of procedures complete to the cecum, procedure duration and detection rates of polyps, any colorectal cancer screening-relevant lesion (adenoma, sessile serrated adenoma, large proximal hyperplastic polyp) and advanced adenomas.From 2013 to 2014, the proportion of diabetics with an inadequate bowel preparation decreased from 7.7% to 3.2% (95% confidence interval for the difference 2.2%-6.8%, P<0.00005). There was no significant change in the proportion of non-diabetics with inadequate preparation (2% in both years). There was no change in secondary outcomes in diabetics from 2013 to 2014.Preferentially scheduling diabetic patients later in the morning that more conveniently allowed for a split dose bowel preparation resulted in decreased rates of inadequate bowel preparation without disadvantaging other patients.

SUBMITTER: Hilsden RJ

PROVIDER: S-EPMC5536294 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description:BackgroundAlthough split-dose bowel regimen is recommended in colon cancer screening and surveillance guidelines, implementation in clinical practice has seemingly lagged because of concerns of patient compliance.ObjectivesTo assess patient compliance with the split-dose bowel regimen and assess patient- and preparation process-related factors associated with compliance and bowel preparation adequacy.DesignProspective survey cohort.SettingTertiary care setting.PatientsAverage-risk patients undergoing colonoscopy for colorectal cancer screening between August 2011 and January 2013.Main outcome measurementsSplit-dose bowel regimen patient-reported compliance and bowel preparation adequacy with the Boston Bowel Preparation Scale score.ResultsSurveys and Boston Bowel Preparation Scale score data were completed in 462 participants; 15.4% were noncompliant with the split-dose bowel regimen, and suboptimal bowel preparation (score <5) was reported in 16% of all procedures. White (P = .009) and married (P = .01) subjects were least likely to be noncompliant, whereas Hispanic subjects and those who reported incomes of US$75,000 or less were most likely to be noncompliant (P = .004). Participants who were noncompliant with split-dosing were less likely to follow the other laxative instructions and more likely to have their colonoscopy appointment before 10:30 am. Compliance differed by bowel preparation type (P = .003, χ(2) test), with those who used MiraLAX showing the highest compliance, followed by polyethylene glycol electrolyte solution and other bowel preparations. Noncompliance with split-dose bowel preparation (odds ratio 6.7; 95% confidence interval, 3.2-14.2) was the strongest predictor of suboptimal bowel preparation.LimitationsPatient self-report, performed at tertiary care center.ConclusionsOverall, 1 in 7 patients do not comply with a split-dose bowel regimen. Ensuring compliance with the split-dose bowel regimen will reduce the risk of a suboptimal bowel preparation.

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Scheduling rules for patients with diabetes mellitus that facilitate split-dosing improve the quality of bowel preparation for colonoscopy.

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