A Call-to-Action Remains
The National Colorectal Cancer Roundtable set forth an ambitious goal in 2014: to screen 80% of eligible Americans by 2018. Unfortunately, two years in to the initiative only a 0.9% increase was achieved. A December 2018 American Journal of Gastroenterology article reviewed 58 studies on reasons patients did not follow through on colon screening. They reported fears of sedation, suffering complications, embarrassment and anticipated pain from the colonoscopy. But the number one concern was…(you guessed it) the prep!*
The Prep Hurdle
The most common repetitive prep-related complaints we hear as physicians involve bad taste, unintended sided effects such as bloating, nausea, and vomiting and the extremely restricted diet.
Growing Body of Evidence
A meta-analysis of nine studies comparing low-residue and clear liquid diets in preparation for colonoscopy showed that patients better tolerate a low-residue diet and are more willing to repeat the preparation. The analysis did not show a difference in the quality of bowel prep between the two approaches. Gastrointest Endosc 2016;83:499-507.
Colon preps are either prescription or OTC laxatives depending on physician and patient preferences. We published an observational study using a standardized low residue food kit and off label laxatives in a novel dosing schedule to minimize unintended side effects. Patient tolerance and prep completion were high with 98% adequate prep (BBPS >6) with average BBPS of 8. Cecal intubation was achieved in all patients except for patients with strictures, obstructing CRC and one poor prep. Patients at high risk for poor prep were NOT EXCLUDED.