April 7th, 2009
Our Love-Hate Relationship with Bowel Preps: It’s Time to Split Up!
For the past couple years, my colleagues and I have been bemoaning the state of bowel preps, especially for colonoscopies done in the afternoon. As many as one third of those preps were so poor that we had to tell patients to resume screening at intervals sooner than 7 to 10 years, for fear of missed lesions.
Thinking the problem was mainly related to the delay between the prep and the procedure, we decided this winter to split the dose (half the day before, and half 4 to 5 hours before the procedure) for all bowel preps — a practice that the ACG also now recommends. Lo and behold, the preps in our clinic are now uniformly good to excellent, regardless of whether the case is seen in the morning or afternoon.
What is your experience with bowel preps and split dosing? Have you had similar success or encountered any obstacles in implementation?
5 Responses to “Our Love-Hate Relationship with Bowel Preps: It’s Time to Split Up!”
M. Brian Fennerty, MD
Editor-in-Chief
NEJM Journal Watch Gastroenterology
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Thanks for the article. Is the product used 5-6 hours before colonscopy, PEG or something else and what amount of water the patients received? I had seen especially older subjects with GI bleeding after colonoscopy suffered severe dehydration, electrolyte imbalance and missed diagnoses for insufficient prep. While it is recommended after stability perform colonoscopy as soon as possible for elderly patients with GI bleeding-is it really diagnostic with insufficient prep? By the way I m not expert in performing total colonoscopy.
Dr. Fennerty, What time do you have the patients take the second half of the prep if they are scheduled in the morning? For example, if they are scheduled for 8 am, do they actually get up at 3 – 4 am for the prep? I can’t see many patients agreeing to doing that. Poor bowel preps are certainly an issue in the endoscopy department where I work. I’m going to suggest to the docs trying the 1/2 and 1/2 prep as you suggest, but maybe only for the afternoon patients to start. Thanks for the tip!
Actually, we already did this with the patients receiving Phosphate preps until they were removed from the market, and my patients have not “rebelled” at all (although they do look somewhat sleepy when I see them at 8am!).
As a practitioner and a patient the 1/2 prep is more pleasant.
As a patient I will say the prep is ridiculously distasteful and uncomfortable. Anyone I asked admitted they never completed full dosage (became nauseous, ill). Most whose resulted in no problems found swear not to do it again until a better prep method is found. The ownership of a multi-step, bad-tasting prep cannot primarily be on a patient in order to be successful.