Adequate bowel prep key to colon cancer prevention via colonoscopy

Adequate cleansing of the bowel in preparation for a colonoscopy is essential for effective detection and removal of suspicious polyps for prevention of colorectal cancer, according to an expert interviewed by Healio Gastroenterology and Liver Disease.

To raise awareness about this important issue during Colorectal Cancer Awareness Month, we spoke with Howard Franklin, MD, vice president of medical affairs and strategy at Salix Pharmaceuticals, and a member of the Society of American Gastrointestinal Endoscopic Surgeons, about how providers can help improve bowel prep quality and adenoma detection rates for more effective colonoscopies.

Healio: Why is achieving a high-quality bowel prep so important for improving adenoma detection rate (ADR)?

Franklin: A colonoscopy is performed to identify polyps and remove them, which can be and often are precancerous. Sometimes polyps are easy to identify — they are long and what we call pedunculated, meaning they are on a long stalk and they look like a little mushroom.

Pedunculated polyps are not a problem for most endoscopists. However, some polyps are what are called sessile polyps — they are rather flat and sort of blend into the mucosa. If you don’t have an adequate bowel prep, meaning if you don’t clean off the mucosa as best as possible, it’s very easy for sessile polyps to be missed — and that’s why adequate bowel prep is so important.

Healio: How can providers better advise colonoscopy patients on how to achieve a high-quality bowel prep?

Franklin: The most important thing for patients to do is strictly adhere to the prescribing instructions. Oftentimes not enough fluid is consumed, or the entire prep is not consumed because maybe it tastes bad, or maybe there’s too much volume of prep, but it’s important that patients consume it all or they will not get an adequate bowel prep.

Healio: Do you have any tips for overcoming patient barriers to split-dosing?

Franklin: There are really no patient barriers to split dosing, as most patients tolerate the bowel prep. There are just patient barriers to the general concept of how split dosing actually improves general compliance. Split dosing improves patient compliance because it’s easier to be done in two sittings with two bottles vs. one sitting with one entire gallon.

Healio: What patients are at risk for an inadequate bowel prep?

Franklin: Patients that come to mind are the elderly, diabetics, those who have trouble swallowing, those who have impaired intestinal motility, and those who are chronically constipated.

Healio: How can providers make an informed choice of available bowel prep options/strategies for their patients? Should the approach be personalized to the patient?

Franklin: I think that providers need to understand the differentiating factors between the preps because all preps are not the same. They are composed of different chemicals, different active ingredients, some preps are more safe and efficacious than others, and the dosing of the preps changes as well. All those factors should go into the provider’s decision-making process.

I think the approach should be personalized depending on the patient’s age, their ability to follow directions, their home situation and their preferences.

Healio: How effective are emerging technologies for improving visualization in inadequately prepped colons?

Franklin: Colonoscopy technology has improved greatly. There are all different types of wavelengths and types of light, improved optics, and I think even newer emerging technologies involve giving dyes to patients to help light up polyps so that they can be seen and detected better. I look forward to continuing to learn more about new and emerging technologies.

Disclosures: Franklin is employed by Salix Pharmaceuticals.