Intraprocedural Cleansing Work During Colonoscopy and Achievable Rates of Adequate Preparation in an Open-access Endoscopy Unit

Background: Rates of adequate bowel preparation in the 60% to 80% range continue to be reported for colonoscopy.

Objective: To describe the rate of adequate bowel preparation and intraprocedural work needed to achieve this rate in an open-access endoscopy unit. Universal split dosing and regimens tailored to medical predictors of inadequate preparation were used.

Design: Prospective observational study.

Setting: Academic hospital outpatient endoscopy unit and ambulatory surgery center.

Patients: Outpatients undergoing colonoscopy.

Interventions: Prospective assessment of preparation quality for colonoscopy during insertion and after intraprocedural cleansing in 525 patients.

Main Outcome Measurements: Rates of adequate preparation and work required to improve cleansing quality. Work time for cleaning was measured with a stopwatch.

Results: Adequate preparation to allow recommendation of standard screening or surveillance intervals was achieved in 96% of patients, including 6% for whom preparation was adequate only after intraprocedural cleansing work. The mean time for intraprocedural cleaning was 4.1 minutes and constituted 17% of total procedure time. Work time for cleaning and fluid volume injected increased when worse preparation grades were identified before cleaning.

Limitations: Single-center study with low percentage (4%) of patients receiving Medicaid.

Conclusion: An open-access unit using split-dose bowel cleansing preparations can achieve high rates of adequate bowel preparation for colonoscopy. Intraprocedural cleansing accounts for a substantial fraction of the total procedure time in colonoscopy and is an important contributor to high rates of adequate preparation.