Introduction NHS Bowelscope screening was recently piloted in 2013 to complement the existing NHS bowel cancer screening programme. Currently there is a paucity of data on whether the timing of the procedure (Morning, afternoon or evening lists) has any impact on the quality of bowel preparation. This study examined the difference in quality of bowel preparation between different sessions of the day, and also whether opening the bowels prior to phosphate enema would have any impact on the quality of subsequent bowel preparation.
Method Patients who participated in the NHS Bowelscope screening programme in the West Kent and Medway bowel cancer screening centres were included. We prospectively gathered data over a 2 months period between 8/12/14 to 7/2/15, looking at the quality of bowel preparation in the AM, PM and evening lists. We also examined whether patients have had their bowels opened prior to phosphate enema, as this may affect the quality.
Results Over the 2 months study period, 574 patients attended for flexible sigmoidoscopy (AM: 242; PM: 277; Evening: 55).
In the AM lists (F: 118 (49%); M: 124 (51%)), 131 patients had good bowel preparation (54%), 68 had adequate bowel preparation (28%), and 43 were deemed inadequate (18%). In the PM lists (F: 128 (46%); M: 149 (54%)), 173 patients had good bowel preparation (63%), 90 patients had adequate bowel preparation (32%) and 14 were deemed inadequate (5%). In the evening lists (F: 26 (47%); M: 29 (53%)), 37 patients had good bowel preparation (67%), 16 patients had adequate bowel preparation (29%), and only 2 were deemed inadequate (4%). Both PM and evening lists had significantly less inadequate preparation compared to the morning lists (p < 0.0001).
In the morning lists, only 160 patients (66%) had their bowels opened prior to phosphate enema. Whereas in the afternoon and evening lists, 233 (84%) and 39 patients (71%) had their bowels opened prior to phosphate enema respectively (p < 0.0001).
Conclusion Our study has shown that the quality of bowel preparation was significantly worse in the AM lists compared with the PM and evening lists (Inadequate bowel preparation in 18% of patients in the AM lists, 5% PM lists, 4% evening lists). Furthermore, less patients had their bowels opened prior to phosphate enema in the AM group (AM 66%, PM 84%, evening 71%).
In light of these findings, changes in practice, such as booking less patients in the morning lists in the event that re-enema is required in order to avoid list overrunning, or, offering double enema, may provide better outcome and ultimately improves adenoma detection rate.
Disclosure of interest None Declared.