Bowel cleansing before colonoscopy： Balancing efficacy,safety, cost and patient tolerance

• 作者: Nicole M Harrison, Michael C Hjelkrem
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: BOWEL preparation COLONOSCOPY Adenomadetection rate MiraLAX Polyethylene GLYCOL Sodiumpicosulfate ORAL SULFATE solution
• 年，卷（期）: 2016,（1）
• 页码范围: 4-12
• 页数: 9页
• 分类号: R

摘要

Effective colorectal cancer screening relies on reliablecolonoscopy findings which are themselves dependenton adequate bowel cleansing. Research has consistentlydemonstrated that inadequate bowel preparationadversely affects the adenoma detection rate and leadsgastroenterologists to recommend earlier follow up thanis consistent with published guidelines. Poor preparationaffects as many as 30% of colonoscopies and contributesto an increased cost of colonoscopies. Patient tolerability isstrongly affected by the preparation chosen and mannerin which it is administered. Poor tolerability is, in turn,associated with lower quality bowel preparations. Recently,several new developments in both agents being usedfor bowel preparation and in the timing of administrationhave brought endoscopists closer to achieving the goal ofeffective, reliable, safe, and tolerable regimens. Historically,large volume preparations given in a single dose wereadministered to patients in order to achieve adequatebowel cleansing. These were poorly tolerated, and theunpleasant taste of and significant side effects producedby these large volume regimens contributed significantlyto patients＇ inability to reliably complete the preparationand to a reluctance to repeat the procedure. Smallervolumes, including preparations that are administered astablets to be consumed with water, given as split doseshave significantly improved both the patient experienceand efficacy, and an appreciation of the importance ofthe preparation to colonoscopy interval have producedadditional cleansing.