title: Intraprocedural cleansing work during colonoscopy and achievable rates of adequate preparation in an open-access endoscopy unit.
abstract: BACKGROUND
  Rates of adequate bowel preparation in the 60% to 80% range continue to be reported for colonoscopy.
  
  
  OBJECTIVE
  To describe the rate of adequate bowel preparation and intraprocedural work needed to achieve this rate in an open-access endoscopy unit. Universal split dosing and regimens tailored to medical predictors of inadequate preparation were used.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Academic hospital outpatient endoscopy unit and ambulatory surgery center.
  
  
  METHODS
  Outpatients undergoing colonoscopy.
  
  
  METHODS
  Prospective assessment of preparation quality for colonoscopy during insertion and after intraprocedural cleansing in 525 patients.
  
  
  METHODS
  Rates of adequate preparation and work required to improve cleansing quality. Work time for cleaning was measured with a stopwatch.
  
  
  RESULTS
  Adequate preparation to allow recommendation of standard screening or surveillance intervals was achieved in 96% of patients, including 6% for whom preparation was adequate only after intraprocedural cleansing work. The mean time for intraprocedural cleaning was 4.1 minutes and constituted 17% of total procedure time. Work time for cleaning and fluid volume injected increased when worse preparation grades were identified before cleaning.
  
  
  CONCLUSIONS
  Single-center study with low percentage (4%) of patients receiving Medicaid.
  
  
  CONCLUSIONS
  An open-access unit using split-dose bowel cleansing preparations can achieve high rates of adequate bowel preparation for colonoscopy. Intraprocedural cleansing accounts for a substantial fraction of the total procedure time in colonoscopy and is an important contributor to high rates of adequate preparation.
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: MacPhail
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Hardacker
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Tiwari
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Krishna C
authors.initials: KC
authors.lastname: Vemulapalli
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
mesh_terms: D000328:Adult; D000368:Aged; D002400:Cathartics; D003113:Colonoscopy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D007507:Therapeutic Irrigation; D013997:Time Factors
chemical_list: D002400:Cathartics