Gut Check on Gastroenterology Archive

There are innumerable bowel preps on the market as well as “home brewed” ones (e.g. Miralax™ and Gatorade™). In my community, many gastroenterology practices appear to choose their colonoscopy prep based on patient acceptability and/or taste preference. I find this choice of bowel prep based on “marketing” to patients troublesome.

Although I absolutely understand the issues of patient satisfaction (I have had two colonoscopy preps), the reality is that the quality of the bowel prep directly correlates with detection of polyps and, thus, ultimately affects the ability of colonoscopy to protect against colon cancer.

In my experience, if patients are given the choice between a bowel prep that tastes good or is easier to use and the “best” one for cleaning the colon (a split-dose, PEG-based prep) and optimizing polyp detection, they will choose the latter. Frankly, I think that the use of any less optimal prep should be accompanied with documentation that the patient is aware of the “risk” associated with use of the alternate prep (missed polyps, possible increased risk for later cancer, need for another colonoscopy earlier than usual, etc.)

So, what is your approach to this issue? Specifically, I am wondering the following:

1)    How do you choose bowel preps in your practice?

2)    If you choose anything other than split-dose, PEG-based preps, do you inform patients that they may have a greater risk for missed polyps?

3)    Do you track bowel prep quality as a quality measure in your practice?

4)    In patients with a suboptimal prep, when do you reschedule them back?

I look forward to the conversation.