Determining Best Practice for Colonoscopy Preparation for Persons with Constipation

Abstract

Abstract According to the American Cancer Society, colorectal cancer is estimated to affect 145,000 people and is expected to cause over 51,000 deaths in the year 2019. The way to prevent colorectal cancer is by early detection through colonoscopy starting at age 50 or, age 40 if there is a strong family history. To cleanse the bowel for this procedure, patients drink a preparation (prep) fluid that induces bowel evacuation. If the preparation is poor, polyps, abnormal tissue, or masses can be missed warranting a repeat procedure. The purpose of this project was focused on determining the best practice for bowel prep for patients with a history of constipation. The project utilized retrospective chart review and assessed the frequency of poor prep diagnoses in persons with a history of constipation and association with the type of prep prescribed for colonoscopy at two Gastrointestinal (GI) clinic locations associated with a Midwest medical center. The overall rate of poor bowel prep was 34% but there was no statistical difference between each clinic’s bowel prep practice in the rates of poor prep among this population. This project also determined that the current rate of repeat colonoscopy completion due to poor bowel prep was 62.5%, 25% of patients at Clinic 1 and 37.5% of patients at Clinic 2. Clinician-perceived barriers to bowel prep standardization included barriers such as: cost to the patient, poor understanding of instructions, and fluid restrictions for comorbidities. The findings from this project determined that there is no need for bowel prep standardization across clinic sites based on prep, as best practice was not determined based on this project, however, prep should be based on patient preference, cost, price, and ability to understand instructions. Keywords: colonoscopy prep, poor colonoscopy prep, constipation and colonoscopy prep