There are innumerable bowel preps on the market as well as \u201chome brewed\u201d ones (e.g. Miralax\u2122 and Gatorade\u2122). 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 \u201cmarketing\u201d to patients troublesome.<\/p>\n
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.<\/p>\n
In my experience, if patients are given the choice between a bowel prep that tastes good or is easier to use and the \u201cbest\u201d 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 \u201crisk\u201d associated with use of the alternate prep (missed polyps, possible increased risk for later cancer, need for another colonoscopy earlier than usual, etc.)<\/p>\n
So, what is your approach to this issue? Specifically, I am wondering the following:<\/p>\n
1)\u00a0\u00a0\u00a0 How do you choose bowel preps in your practice?<\/p>\n
2)\u00a0\u00a0\u00a0 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?<\/p>\n
3)\u00a0\u00a0\u00a0 Do you track bowel prep quality as a quality measure in your practice?<\/p>\n
4)\u00a0\u00a0\u00a0 In patients with a suboptimal prep, when do you reschedule them back?<\/p>\n
I look forward to the conversation.<\/p>\n","protected":false},"excerpt":{"rendered":"
There are innumerable bowel preps on the market as well as \u201chome brewed\u201d ones (e.g. Miralax\u2122 and Gatorade\u2122). 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 \u201cmarketing\u201d to patients troublesome. Although I absolutely understand the […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,13],"tags":[23,52],"class_list":["post-498","post","type-post","status-publish","format-standard","hentry","category-colonoscopy","category-patient-care","tag-bowel-preparation","tag-screening-colonoscopy"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts\/498","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/comments?post=498"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts\/498\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/media?parent=498"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/categories?post=498"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/tags?post=498"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}