Introduction Effective bowel preparation of ≥90% is a key quality indicator for ensuring good standards of colonoscopy1. Good quality bowel preparation improves polyp detection and caecal intubation rates. Various regimens used in Mid-Yorkshire NHS Trust (MYNHT) were assessed in 2008 leading to a change in practise. As a result, Citramag and Senna have been used in split doses since then. Aims of the study were to determine the efficacy of Citramag/Senna, and patient acceptability & tolerability of this regimen. Performance of this regimen was compared to Kleen Prep and oral Fleet used previously.
Methods We prospectively studied data collected from pre-procedure questionnaires completed by patients between Aug 2010 & May 2011. Endoscopists scored bowel cleansing according to Boston Bowel Prep Scale (BBPS) for each segment (0–3)2, on the basis of guidance images and scoring system provided for the duration of the study. Qualitatively, bowel cleansing was graded as A, B or C, where A = all segments clean, B = partially removable stool preventing complete visualisation in at least one segment and C = solid stool in at least one segment. Exclusion criteria were used to philtre patients who received regimens other than Citramag/Senna, those with incomplete data and those who had had colonic resection.
Results A total of 194 questionnaires were received during the study period. Of these, 19 patients were excluded from further analysis on the basis of criteria detailed above. Of the remaining 175 cases assessed, 88% patients found taste of the preparation acceptable or pleasant. 92.5% were willing to take the same regime again. 44% patients had adverse effects of which 77% were mild. This compared favourably to results of Kleen-Prep (62.9%) & Fleet (66.2%). Abdominal cramp was the commonest side effect. Mean total BBPS score was 16.91 (maximum score possible 18). 93.14% cases were graded A (qualitative score) implying good efficacy of bowel preparation, compared to 45.1% for Kleen-Prep and 69% for Fleet.
Conclusion The split-dose regimen of Citramag/Senna meets the Joint Advisory Group (JAG) recommendation for bowel cleansing with efficacy of >90% and is better than other regimens previously used in MYNHT. We also found this to be superior to Kleen-Prep and oral Fleet in terms of patient acceptability and adverse effects. Hence, we recommend continuing with the current regimen, and re-assessing this to ensure ongoing efficacy/benefit. BBPS should be considered for use as a standard scoring tool for assessing efficacy of bowel preparation. However, further validation is required to demonstrate its applicability in day-to-day endoscopy.
Disclosure of Interest None Declared
BSG quality and safety indicators for endoscopy. Mar 2007
Calderwood A & Jacobson B. Comprehensive validation of Boston bowel preparation scale. Gastrointestinal Endosc. 2010 October; 72(4): 686–692
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