Colonoscopy

Evaluating the Referral Pathway for Colonoscopy in a District General Hospital (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Lakshmipathy G.R.; *Zaman H.; *Ball W.; *Smith M.

Citation:

British Journal of Surgery. Conference: 49th ASiT Annual Surgical Conference. Belfast United Kingdom. 112(Supplement 10) (pp x109-x110), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Objectives: We aim to evaluate: Method, urgency and appropriateness of colonoscopy referrals. Colonoscopies repeated within two years. Reasoning behind procedure modification or cancellation on the day Method: Data was collected between 5/1/24 and 28/2/24 using questionnaires completed by endoscopists. 112 colonoscopies in 51% (57) males and 49% (55) females were included. Result(s): The most common to least common referral sources are: Colorectal CNS telephone clinic 29(26%), consultant surgeon face-to-face Clinic 28(25%), triage system 14(12.5%), consultant surgeon telephone clinic 13(11.6%), others 13(11.6%), gastroenterology consultant face-to-face clinic 11(9.8%) and gastroenterologist telephone clinic 1(0.8%). Majority of referrals were two-week wait or urgent 97 (86.5%). Endoscopists were 18-week team 70(62.5%) followed by trust-employed consultant surgeons 26(23%). Four patients had repeat colonoscopies in last two years. 9(8%) scopes were modified or cancelled. Conclusion(s): Except for one scope, repeat scopes within two years had valid indications. Majority of the modified or cancelled scopes originated from telephone consultation referrals. Reasons for cancellation on the day included lack of fitness for scopy, ineffective bowel preparation, patient factor like uncontrolled atrial fibrillation on the day and no indication for colonoscopy. Modifications included switching from requests for flexible sigmoidoscopy to colonoscopy; colonoscopy to CTVC and vice versa. In light of this study, we aim to provide face-to-face appointments for patients referred through the urgent suspected cancer pathway. We plan to expand this study to evaluate the popularity of CTVC use as an alternative modality when colonoscopy is not possible.

DOI: 10.1093/bjs/znaf128.znaf128.438

Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta-analysis (2020)

Posted on by

Type of publication:
Systematic Review

Author(s):
Kamran, Umair; *Abbasi, Abdullah; Tahir, Imran; Hodson, James; Siau, Keith

Citation:
United European gastroenterology journal; 2020 Dec; 8(10):1217-1227.

Abstract:
BACKGROUND Bowel preparation for colonoscopy is often poorly tolerated due to poor palatability and adverse effects. This can negatively impact on the patient experience and on the quality of bowel preparation. This systematic review and meta-analysis was carried out to assess whether adjuncts to bowel preparation affected palatability, tolerability and quality of bowel preparation (bowel cleanliness).METHODS A systematic search strategy was conducted on PubMed, MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews to identify studies evaluating adjunct use for colonoscopic bowel preparation. Studies comparing different regimens and volumes were excluded. Specific outcomes studied included palatability (taste), willingness to repeat bowel preparation, gastrointestinal adverse events and the quality of bowel preparation. Data across studies were pooled using a random-effects model and heterogeneity assessed using I2-statistics.RESULTS Of 467 studies screened, six were included for analysis (all single-blind randomised trials; n = 1187 patients). Adjuncts comprised citrus reticulata peel, orange juice, menthol candy drops, simethicone, Coke Zero and sugar-free chewing gum. Overall, adjunct use was associated with improved palatability (mean difference 0.62, 95% confidence interval 0.29-0.96, p < 0.001) on a scale of 0-5, acceptability of taste (odds ratio 2.75, 95% confidence interval: 1.52-4.95, p < 0.001) and willingness to repeat bowel preparation (odds ratio 2.92, 95% confidence interval: 1.97-4.35, p < 0.001). Patients in the adjunct group reported lower rates of bloating (odds ratio 0.48, 95% confidence interval: 0.29-0.77, p = 0.003) and vomiting (odds ratio 0.47, 95% confidence interval 0.27-0.81, p = 0.007), but no difference in nausea (p = 0.10) or abdominal pain (p = 0.62). Adjunct use resulted in superior bowel cleanliness (odds ratio 2.52, 95% confidence interval: 1.31-4.85, p = 0.006). Heterogeneity varied across outcomes, ranging from 0% (vomiting) to 81% (palatability), without evidence of publication bias. The overall quality of evidence was rated moderate.CONCLUSION In this meta-analysis, the use of adjuncts was associated with better palatability, less vomiting and bloating, willingness to repeat bowel preparation and superior quality of bowel preparation. The addition of adjuncts to bowel preparation may improve outcomes of colonoscopy and the overall patient experience.

Link to full-text [no password required]