The inpatient Colonoscopy: A Difficult Endeavor

Enns, Robert; Krygier, Darin

doi:10.1155/2008/826271

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…Additionally, this study included only colonoscopies performed on an outpatient basis, which comprise the majority of colonoscopies and tend to have lower incomplete rates than those performed as inpatient procedures. 26 Clinical trials of bowel preparation agents indicate that in approximately 1–5% of cases, the cecum could not be intubated (incomplete colonoscopy), which is similar to the rates seen in this study. 27 , 28 …”

Section: Discussionsupporting

confidence: 83%

Real-world comparison of the effectiveness and safety of different bowel preparation agents

Sacks¹,

Sharma²,

Cyr³

et al. 2018

CEG

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Background and aimsProper bowel cleansing is necessary prior to colonoscopy, but poor tolerability to bowel preparation agents may increase the odds of poor cleansing and incomplete screenings. The aim of this study was to evaluate the real-world effectiveness and safety of bowel preparation agents.MethodsClaims data were extracted for individuals who had a screening colonoscopy from July 1, 2012, to June 30, 2015, were ≥18 years of age, and who could be observed ≥6 months before and ≥3 months after the screening. Data were stratified by agent class, including over-the-counter (OTC), low-volume (LV), and high-volume (HV) agents. Rates of incomplete screenings, repeat screenings, and hospitalizations were reported. Multivariate logistic regression was conducted to compare outcomes for sodium picosulfate, magnesium oxide, and citric acid (P/MC) vs other agents.ResultsOf 2.8 million individuals, 71.5% were average risk and 28.5% were high risk for colorectal cancer. Rates of use were 2.8% for P/MC, 30.1% for other LV agents, 9.4% for HV agents, and 56.6% for OTC agents. All individuals who used P/MC had significantly lower odds of incomplete screenings compared to those who used other LV agents or HV agents (P<0.05). In average-risk patients, rates of 30- and 90-day repeat screenings were highest for the P/MC group (16.7% and 23.0%, respectively) compared to other agents. Across all patient analysis groups, the rates of hospitalizations for hyponatremia or dehydration were much higher for those who used an OTC bowel preparation agent compared to those who used LV or HV agents, or P/MC.ConclusionP/MC was associated with lower rates of incomplete colonoscopy and higher rates of repeat screenings, suggesting it was better tolerated than other agents. OTC agents were associated with higher rates of hospitalizations.

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Section: Discussionsupporting

confidence: 83%

Real-world comparison of the effectiveness and safety of different bowel preparation agents

Sacks¹,

Sharma²,

Cyr³

et al. 2018

CEG

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show abstract

“…Patients tend to have poor preparation and mobility status and their colonoscopies tend to be difficult to complete. Urgent colonoscopy is technically challenging, and is logistically complicated and resource intensive and it may not be appropriate or feasible for some patients (2,21). In this study, 72% of patients had colonoscopy done with a mean time of four days after admission; of this total, 39% had the test done within three days.…”

Section: Discussionmentioning

confidence: 77%

Acute Lower Gastrointestinal Bleed: Review of Clinical Course and Outcome in Hospitalized Patients

Fairclough¹,

Mills²,

Mullings³

et al. 2016

West Indian Med J

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Methods: Consecutive patients admitted with ALGIB were reviewed. Data collected comprised age, gender, prior episodes of ALGIB, co-morbid illness, vital signs, blood transfusion requirements, timing of colonoscopy and/or findings at surgery and outcomes. Results: There were 189 patients reviewed with a mean age of 67 years. There was a predominance of females (55% vs 45%) with 80% of patients having at least one co-morbid illness. The use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) was present in 24% and 16% of patients, respectively. A previous diagnosis of diverticular disease was found in 31%. Colonoscopy was performed in 72% of patients with a median time of four days to the procedure. Overall, 19% of patients required emergency surgery with no deaths. The leading causes of ALGIB were diverticular disease 56%, colorectal cancer and haemorrhoidal disease 11% each and colonic polyps 8.5%. Recurrent bleeding occurred in 3.7% and blood transfusion was given in 43%. The average hospitalization stay was seven days, eight days for patients 65 years or older. Overall mortality was 2.6%. Conclusion:Acute lower gastrointestinal bleed occurred most frequently in the elderly population with the majority afflicted with co-morbid illnesses. Diverticular disease was the most common cause. Overall mortality (2.6%) was low and emergency surgery is associated with low mortality. Older patients had a longer hospital stay.

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“…Inadequate bowel preparation can preclude satisfactory visualization of the colon and result in diagnostic uncertainty requiring repeated or alternative testing (Yadlapati et al, 2018;Hendry et al, 2007). As a result, hospital length of stay can be extended up to 25 percent and associated costs may increase by as much as 22 percent (Hendry et al, 2007;Enns and Krygier, 2008). Improvement in the quality of inpatient bowel preparations should enhance initial endoscopic mucosal visualization and reduce incomplete or non-diagnostic procedures.…”

Section: Introductionmentioning

confidence: 99%

“…Improvement in the quality of inpatient bowel preparations should enhance initial endoscopic mucosal visualization and reduce incomplete or non-diagnostic procedures. As a result, patients and providers may experience less frustration, shorter hospital stays and reduced resource utilization (Lee et al, 2015;Enns and Krygier, 2008;Strate and Syngal, 2003).…”

Section: Introductionmentioning

confidence: 99%

Standardizing inpatient colonoscopy preparations improves quality and provider satisfaction

Sullivan

Zhang

Wegermann

et al. 2020

IJHCQA

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PurposeInpatient colonoscopy bowel preparation quality is frequently suboptimal. This quality improvement (QI) intervention is focused on regimenting this process to impact important outcomes.Design/methodology/approachDefine, Measure, Analyze, Improve and Control (DMAIC) methodology was employed, including generating a root-cause analysis to identify factors associated with inpatient bowel quality. These findings motivated the creation of a standardized electronic health record (EHR)-based order set with consistent instructions and anticipatory guidance for administering providers.FindingsThere were 264 inpatient colonoscopies evaluated, including 198 procedures pre-intervention and 66 post-intervention. The intervention significantly improved the adequacy of right colon bowel preparations (75.0 percent vs 86.9 percent, p = 0.04) but not overall preparation quality (73.7 percent vs 80.3 percent, p = 0.22). The intervention led to numerical improvement in the proportion of procedures in which the preparation quality interfered with making a diagnosis (10 percent–6 percent, p = 0.29) or resulted in an aborted procedure (3.5 percent–1.5 percent, p = 0.39). After the intervention, provider satisfaction with the ordering process significantly increased (23.3 percent vs 61.1 percent, p < 0.001).Practical implicationsThe QI intervention significantly reduced the number of inpatient colonoscopies with inadequate preparation in the right colon, while also modestly improving the diagnostic yield and proportion of aborted procedures. Importantly, the standardized EHR order set substantially improved provider satisfaction, which should justify broader use of such tools.Originality/valueNovel clinical outcomes such as ability to answer diagnostic questions were improved using this intervention. The results align with strategic goals to enhance provider experience and continuously improve quality of patient care.

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The inpatient Colonoscopy: A Difficult Endeavor

Cited by 7 publications

References 15 publications

Real-world comparison of the effectiveness and safety of different bowel preparation agents

Real-world comparison of the effectiveness and safety of different bowel preparation agents

Acute Lower Gastrointestinal Bleed: Review of Clinical Course and Outcome in Hospitalized Patients

Standardizing inpatient colonoscopy preparations improves quality and provider satisfaction

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