Shorter preparation to procedure interval for colonoscopy improves quality of bowel cleansing

BACKGROUND The timing of bowel preparation for colonoscopy influences the quality of bowel cleansing and the success of the procedure. AIM We aimed to determine whether the interval between the end of bowel preparation and the start of colonoscopy influences preparation quality. METHODS We retrospectively analysed 1785 colonoscopies performed between January 2010 and January 2011. The quality of bowel cleansing was compared between those who had a less than 8-h interval between the end of bowel preparation to the start of the procedure versus those who had a greater than 8-h interval. Univariate and multivariate logistic regression analyses evaluated quality of bowel cleansing, preparation to procedure time, age, gender, hospital inpatient or outpatient status, indication for colonoscopy, caecal intubation rate, and segmental polyp detection. RESULTS Fifty-three per cent of the cohort was male. Eighty-nine per cent were outpatients. Bowel cleansing was reported as satisfactory/good in 87% and poor in 13%. A 8-h interval (odds ratio (OR) 1.3, P = 0.04). In a multivariate analysis, female gender (OR 1.4, P = 0.02), outpatient status (OR 3.1 P = 0.001) and indication for procedure (P 8 h) interval. Adequate bowel preparation led to improved caecal intubation rates.R. V. Bryant, S. N. Schoeman and M. N. Schoema

Optimising the expansion of the National Bowel Cancer Screening Program

Objectives: To estimate the impact of various expansion scenarios of the National Bowel Cancer Screening Program (NBCSP) on the number of bowel cancer deaths prevented; and to investigate the impact of the expansion scenarios on colonoscopy demand. Design: MISCAN-Colon, a well established, validated computer simulation model for bowel cancer screening, was adjusted to reflect the Australian situation. In July 2013, we simulated the effects of screening over a 50-year period, starting in 2006. The model parameters included rates of participation in screening and follow-up, rates of identification of cancerous and precancerous lesions, bowel cancer incidence, mortality and the outcomes of the NBCSP. Five implementation scenarios, based on biennial screening using an immunochemical faecal occult blood test, were developed and modelled. A sensitivity analysis that increased screening participation to 60% was also conducted. Participants: Australian residents aged 50 to 74 years. Main outcome measures: Comparison of the impact of five implementation scenarios on the number of bowel cancer deaths prevented and demand for colonoscopy. Results: MISCAN-Colon calculated that in its current state, the NBCSP should prevent 35 169 bowel cancer deaths in the coming 40 years. Accelerating the expansion of the program to achieve biennial screening by 2020 would prevent more than 70 000 deaths. If complete implementation of biennial screening results in a corresponding increase in participation to 60%, the number of deaths prevented will increase across all scenarios. Conclusions: The findings strongly support the need for rapid implementation of the NBCSP. Compared with the current situation, achieving biennial screening by 2020 could result in 100% more bowel cancer deaths (about 35 000) being prevented in the coming 40 years