Gastroenterologists can make bowel preparations easier for patients while achieving a high-quality colonoscopy, according to Jennifer Weiss, MD, MS, associate professor at the University of Wisconsin, who is discussing the topic during Digestive Disease Week® (DDW) 2024.
“A good quality bowel prep is important for a high-quality colonoscopy, but achieving a good bowel prep is complex,” says Dr. Weiss. “If patients are less intimidated by the bowel preparation, we could see more patients undergo colorectal cancer screening. They would get higher-quality exams and be more likely to come back for their next colonoscopy.”
Dr. Weiss provides several considerations for gastroenterologists and endoscopists to improve:
Educate patients on the aspects of a good bowel prep. New evidence confirms that patient education can improve bowel preps, says Dr. Weiss. Patient education can take many forms, including verbal and written instructions, videos, patient navigator text messages or mobile apps.
Tailor the bowel prep to the patient. Factors such as obesity, diabetes and medications that slow the motility of the GI tract are risk factors for inadequate bowel preparations, says Dr. Weiss. But many healthcare systems do not have an automated way for gastroenterologists to identify these patients.
“Many places have blanket bowel prep protocols for anyone undergoing a screening colonoscopy,” she says. “If we could incorporate more targeted, automated flags in the electronic health record, we might be able to use fewer resources while safely tailoring our bowel prep regimens.”
Consider new recommendations for patients on glucagon-like peptide 1 (GLP-1) agonists. As the popularity of GLP-1 agonists grows, gastroenterologists need to be aware of evolving recommendations on how to tailor the bowel preparation for these patients, says Dr. Weiss. GLP-1 agonists have been associated with inadequate bowel preparation because they decrease GI motility and gastric emptying, leading to concern about the potential for aspiration risk with sedation.
In light of these concerns, the American Society of Anesthesiologists recommends that GLP-1 agonists be held in patients undergoing endoscopic procedures, regardless of whether they are on the medication for diabetes or weight loss. For patients on weekly dosing, this could involve holding the medication for one week prior to the procedure.
A recent clinical practice update by the American Gastroenterological Association recommends a more individualized approach that considers the reason patients are on the GLP-1 agonist and whether they have any symptoms of incomplete gastric emptying.
Ultimately, Dr. Weiss notes, both organizations stress the need for more data to ensure that patients on GLP-1 agonists can safely undergo endoscopic procedures.
Determine whether the bowel prep can be more convenient for the patient. “One of the major barriers we hear from patients agreeing to a colonoscopy is how difficult the bowel prep is,” says Dr. Weiss. “We need to consider what we can do to make it easier for them while still providing the level of cleaning needed for a good colonoscopy.”
Fortunately, new evidence suggests that several aspects of the bowel prep can be made more convenient for patients without compromising the quality of the colonoscopy. Dr. Weiss highlights recent evidence supporting several ways to make bowel preps more convenient for patients:
- Dietary modifications may not be necessary until the day before the bowel prep.
- Lower volume bowel preparations are comparable to the four-liter bowel preparations in terms of cleaning and are better tolerated by patients.
- Oral simethicone can decrease bubbles in the colon. This is particularly important in light of recent warnings by the U.S. FDA about adding dimethicone solution to the water sources during colonoscopy due to deleterious effects on the endoscopes.
Dr. Weiss’s oral presentation, “Changes in colon cancer screening: updates in bowel prep” on Saturday, May 18, at 4:35 p.m. EDT is part of the session “Challenges in Colon Cancer Screening.”
One Response
Excellent thoughtfulness regarding the colon prep. I am all for it and have been trying to modify for the patients, to some extent, by myself.
How wonderful it would be if multiple different colon preps are available in the market, to pick the most appropriate one.