Introduction Bowel preparation is essential for successful lower GI endoscopy but can be unpleasant for patients. Responding to the NPSA alert (NPSA/2009/RRR012) the BSG issued draft guidelines, stipulating assessment and eGFR for all patients and product depending on patient risk (risks; CCF, low eGFR, cirrhosis, diuretics/ACEi/ARB/NSAIDs). Compliance will have service implications for most units. We aimed to determine the effect of oral bowel cleaning agents on patient experience and quantify the service implications of the draft guidelines.
Methods All colonoscopies performed in Oct 2009 were included. Data were obtained from patient interview, hospital IT systems and Unisoft. A structured patient telephone interview evaluating side-effects, assessment process and their experience was determined using a satisfaction scale (1=much worse than expected 2=slightly worse 3=as expected 4=slightly better 5=much better) or a severity scale (between 1=none and 5=worst imaginable).
Results General: 265 colonoscopies (M/F 1:1) were performed, 186 patients were contacted with 115 responding (sample rate 43% uptake rate 61.8%). Mean age was 62.2 years (SD 14.5, 58% male). 96.5% took all the bowel preparation, with unpleasant side effects (incontinence, pain, nausea/vomiting, faint, dizzy, collapse) in 23.5%. Median responses for; experience of the bowel prep and overall experience, were 3 (as expected). For; pain caused by prep, prep affecting decision to have a repeat test and severity of side effects, the medians were 1 (none). However prep had a moderate (score 3) impact on their lives.
BSG Guidelines 97.4% were reviewed before colonoscopy and 98.3% received written instructions. 20% had no traceable eGFR. Interestingly 22% of patients with no comorbidities and no medications had GFR<60. 38.2% were “at risk” (neprotoxic drugs, low eGFR, significant comorbidities). Overall 6.9% has adverse side effects (collapse, dizzy, fainting). Incidence of adverse side effects was higher in those with eGFR <60 (17.9%) than those with eGFR >60 (4.7%). Significant comorbidity identified 50% of patients with adverse side-effects, comorbidity and medication identified 62.5%, while eGFR <60 and comorbidity combined (± medication) increased the sensitivity to 87.5%.
Conclusion The majority manage the full bowel preparation but almost a quarter experienced side-effects. Service provision for eGFR would be required in 20%. The “at-risk” classification identifies some patients with adverse side effects but a combination of eGFR <60 and significant comorbidities (cirrhosis, CCF) was more sensitive. A service stratification using PEG based preparations for patients with eGFR<60, Cirrhosis or CCF or changing to just using PEG preparations is being reviewed locally as a solution to the guidance.