1. Bowel Preparation Regimens Danielle Goodrich, MSIV University of Maryland School of Medicine

2. Overview Colorectal Cancer Bowel Preparation Regimens Survey 2

3. Colorectal Cancer Third most common cancer Second leading cause of cancer-related deaths Screening colonoscopy has been shown to reduce mortality ▫U.S Preventive Services Task Force recommends Colorectal Cancer Screening for those aged 50 years and above with average risk USPSTF 2009 3

4. Adequacy of Colonoscopy Depends on Prep 4

5. Adequacy of Colonoscopy Up to 25% of patients undergoing colonoscopy have poor bowel preparation ▫Lowers the detection of small polyps (<9mm) ▫Increased risk of procedural complications ▫Decreased completion rates ▫Increases the time the endoscopist takes to try to suction and clean the colon Van Dongen 2011 5

6. Liquid coming from the bowel before colonoscopy should look like…. 6

7. Different Dosing Regimens Split-Dose Traditional Same Day Time of day 7

8. Split-Dose Superior to full-dose PEG with respect to ▫Colon Cleansing ▫Patient compliance ▫Patient’s willingness to repeat the same bowel preparation ▫Nausea Kilgore et al 2011 8

9. Survey of Local CRF Programs in Maryland 13 questions aimed to identify practice habits of endoscopists involved in the program Program managers in each county of Maryland who work directly with endoscopists through the statewide Cigarette Restitution Fund Colorectal Cancer Screening Program 9

10. Survey Results: Client Education 10

11. Survey Results: Supplier of the Preparations 11

12. Survey Results: Bowel Preparations 12

13. Survey Results: Bowel Preparations 13

14. Survey Results 14

15. Results Cont’d 15

16. Conclusions Physicians are implementing split dose regimens into their practice. Physicians are using different bowel preps for different patients, suggesting they are taking into account the patients past medical history and ability to complete the various regimens. 16

17. Conclusion The literature suggests that split-dose regimens: ▫Improve quality of the study ▫Reduce cost and complications ▫Are more favorable to the patient 17

18. Information for the screening programs: Please encourage your providers to use split- dosing regimens if not using split dose currently Please disseminate our “Information to the Provider” handout to the endoscopists in your program 18

19. Acknowledgements Many thanks to the program managers in the Cigarette Restitution Fund colorectal cancer screening program at the local health departments in Maryland who collected and submitted the data for this survey Maryland DHMH Center for Cancer Prevention and Control 19

20. References Monica Van Dongen. Enhancing Bowel Preparation for Colonoscopy. Gastroenterology Nursing (2012) 35;36-44. Dwyer DM et al. Experience of a public health colorectal cancer testing program in Maryland. Public Health Reports (2012)127:330- 339. Unger RZ et al. Willingness to Undergo Split-Dose Bowel Preparation for Colonoscopy and Compliance with Split-Dose Instructions. Dig Dis Sci (2010) 55:2030-2034. Di Palma J and Rex D. Advances in Bowel Preparations. Gastroenterology Nursing (2011) 55:S2-S8 Kilgore et al. Bowel Preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials. Gastrointestinal Endoscopy (2011) 73:1240-1245. Longcroft-Wheaton G and Bhandari P. Same-Day Bowel Cleansing Regimen is Superior to a Split-Dose Regimen over Two Days for Afternoon Colonoscopy. J Clin Gastroenterol (2012)46:57-61 20