title: Usefulness of an intensive bowel cleansing strategy for repeat colonoscopy after preparation failure.
abstract: BACKGROUND
  No consensus exists regarding the optimal bowel preparation regimen for patients with poor bowel cleansing at a previous colonoscopy.
  
  
  OBJECTIVE
  We investigated the usefulness of an intensive cleansing regimen for repeat colonoscopy after previous failure of bowel preparation.
  
  
  METHODS
  A prospective observational study was performed in patients undergoing colonoscopy at a university-based, tertiary referral hospital.
  
  
  METHODS
  Outpatients with inadequate preparation at an index colonoscopy were offered a repeat colonoscopy and instructed to follow an intensive preparation regimen consisting of a low-fiber diet for 72 hours, liquid diet for 24 hours, bisacodyl (10 mg) in the evening of the day before the colonoscopy, and a split dose of polyethylene glycol (1.5 L in the evening before and 1.5 L in the morning on the day of the colonoscopy).
  
  
  METHODS
  The adequacy of bowel cleansing was assessed according to the Boston Bowel Preparation Scale (0 or 1 on any colon segment = inadequate bowel preparation). Procedural variables, detection rates for polyps and adenomas, compliance, and tolerability of the regimen were assessed. Satisfaction with the regimen was assessed with a 10-point visual analog scale.
  
  
  RESULTS
  Of 83 patients with inadequate bowel preparation at colonoscopy, 51 underwent a second colonoscopy and were analyzed; 46 patients (90.2%) had adequate bowel cleansing at the second colonoscopy, with a mean (SD) total Boston Bowel Preparation Scale score of 7.43 (1.5) and scores of 2.31 (0.6) for the right colon, 2.49 (0.6) for the transverse colon, and 2.63 (0.6) for the left colon. Polyps, flat lesions, or flat lesions proximal to the splenic flexure were found in significantly more patients at the second colonoscopy than at the index colonoscopy. The global satisfaction score was 6.6 (2.7).
  
  
  CONCLUSIONS
  The study was limited because of its open observational design, possible patient learning effect for bowel preparation at the repeat colonoscopy, and the inclusion of only outpatients.
  
  
  CONCLUSIONS
  An intensive regimen consisting of a low-fiber diet, bisacodyl, and a split dose of polyethylene glycol can achieve good colon preparation with an improved detection rate for polyps and adenomas in most patients who have had poor bowel cleansing at a previous colonoscopy.
authors: Endoscopy Unit, Department of Gastroenterology, Asturias Central University Hospital, Oviedo, Spain.
authors: Mercedes
authors: M
authors: Ibáñez
authors: Adolfo
authors: A
authors: Parra-Blanco
authors: Paz
authors: P
authors: Zaballa
authors: Alejandro
authors: A
authors: Jiménez
authors: Rosario
authors: R
authors: Fernández-Velázquez
authors: Jacobo Ortiz
authors: JO
authors: Fernández-Sordo
authors: Oscar
authors: O
authors: González-Bernardo
authors: Luis
authors: L
authors: Rodrigo
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D001726:Bisacodyl / Q000008:administration & dosage*; D002400:Cathartics / Q000008:administration & dosage*; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy; D004032:Diet; D004043:Dietary Fiber; D004326:Drinking; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011446:Prospective Studies
chemical_list: D002400:Cathartics; D004043:Dietary Fiber; D001726:Bisacodyl; D011092:Polyethylene Glycols