Nationwide variability of colonoscopy preparation instructions

Patients undergoing colonoscopy are typically provided preparation instructions. However, these are not standardized for type of bowel purgative, dietary restrictions, or management of prescription and nonprescription medications.

To examine the degree of variability in colonoscopy instructions across the USA.

Collected colonoscopy preparation instructions from endoscopy units that successfully participated in the American Society for Gastrointestinal Endoscopy's Endoscopy Unit Recognition Program (EURP). Descriptive statistics were used to describe the variability in bowel preparation, dietary restrictions, medication instructions, and other patient advice.

Preparation instructions were available from 201 (49%) of 411 EURP units. Split dosing of bowel purgatives was used by 82% of practices, although 79 units (39%) offered instructions for both single- and split-dose regimens and 18% of units relied only on single-dose regimens. Patients were restricted to a clear liquid diet on the day prior to the colonoscopy by 91% of practices, but other specific dietary instructions (such as avoidance of nuts or legumes) varied. Instructions for the management of anti-thrombotic and anti-platelet agents, nonsteroidal anti-inflammatory drugs and diabetes medications varied widely among practices. Geographic variations in instructions were also observed. Compared to units in the northeast, units in the west were more likely to rely on split-dose preparations exclusively (p = 0.05) and units in the south were less likely to include instructions on warfarin management (p < 0.02). Units throughout the USA were less likely to specifically recommend continuing aspirin use compared to the northeast (p < 0.02).

Despite national recommendations for use of split-dose bowel purgatives, many practices are still relying on single-dose preparations. Clear liquid diets are widely recommended for the day prior to the colonoscopy, despite a lack of data to support the need for such a strict dietary regimen. Patients receive disparate instructions regarding the management of their medications. These findings suggest a need for more evidence-based and comprehensive colonoscopy preparation instructions.