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Bowel Preparation Regimens

Bowel Preparation Regimens. Danielle Goodrich, MSIV University of Maryland School of Medicine. Overview. Colorectal Cancer Bowel Preparation Regimens Survey. Colorectal Cancer. Third most common cancer Second leading cause of cancer-related deaths

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Bowel Preparation Regimens

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  1. Bowel Preparation Regimens Danielle Goodrich, MSIV University of Maryland School of Medicine

  2. Overview • Colorectal Cancer • Bowel Preparation Regimens • Survey

  3. Colorectal Cancer • Third most common cancer • Second leading cause of cancer-related deaths • Screening colonoscopy has been shown to reduce mortality • U.S Preventive Services Task Force recommends Colorectal Cancer Screening for those aged 50 years and above with average risk USPSTF 2009

  4. Adequacy of Colonoscopy Depends on Prep

  5. Adequacy of Colonoscopy • Up to 25% of patients undergoing colonoscopy have poor bowel preparation • Lowers the detection of small polyps (<9mm) • Increased risk of procedural complications • Decreased completion rates • Increases the time the endoscopist takes to try to suction and clean the colon Van Dongen 2011

  6. Liquid coming from the bowel before colonoscopy should look like….

  7. Different Dosing Regimens Split-Dose Same Day Traditional Time of day

  8. Split-Dose • Superior to full-dose PEG with respect to • Colon Cleansing • Patient compliance • Patient’s willingness to repeat the same bowel preparation • Nausea Kilgore et al 2011

  9. Survey of Local CRF Programs in Maryland • 13 questions aimed to identify practice habits of endoscopists involved in the program • Program managers in each county of Maryland who work directly with endoscopists through the statewide Cigarette Restitution Fund Colorectal Cancer Screening Program

  10. Survey Results: Client Education

  11. Survey Results: Supplier of the Preparations

  12. Survey Results: Bowel Preparations

  13. Survey Results: Bowel Preparations

  14. Survey Results

  15. Results Cont’d

  16. Conclusions • Physicians are implementing split dose regimens into their practice. • Physicians are using different bowel preps for different patients, suggesting they are taking into account the patients past medical history and ability to complete the various regimens.

  17. Conclusion • The literature suggests that split-dose regimens: • Improve quality of the study • Reduce cost and complications • Are more favorable to the patient

  18. Information for the screening programs: • Please encourage your providers to use split-dosing regimens if not using split dose currently • Please disseminate our “Information to the Provider” handout to the endoscopists in your program

  19. Acknowledgements • Many thanks to the program managers in the Cigarette Restitution Fund colorectal cancer screening program at the local health departments in Maryland who collected and submitted the data for this survey • Maryland DHMH Center for Cancer Prevention and Control

  20. References • Monica Van Dongen. Enhancing Bowel Preparation for Colonoscopy. Gastroenterology Nursing (2012) 35;36-44. • Dwyer DM et al. Experience of a public health colorectal cancer testing program in Maryland. Public Health Reports (2012)127:330-339. • Unger RZ et al. Willingness to Undergo Split-Dose Bowel Preparation for Colonoscopy and Compliance with Split-Dose Instructions. Dig DisSci (2010) 55:2030-2034. • Di Palma J and Rex D. Advances in Bowel Preparations. Gastroenterology Nursing (2011) 55:S2-S8 • Kilgore et al. Bowel Preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials. Gastrointestinal Endoscopy (2011) 73:1240-1245. • Longcroft-Wheaton G and Bhandari P. Same-Day Bowel Cleansing Regimen is Superior to a Split-Dose Regimen over Two Days for Afternoon Colonoscopy. J ClinGastroenterol (2012)46:57-61

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