Most UK endoscopy units do not recommend split bowel preparation for morning endoscopy; 2023 resurvey of UK bowel preparation practice

Bowel preparation for colonoscopy is vital to allow visualisation of the mucosa and assessment for pathology. However, poor preparation is common, seen in up to 25% of procedures. Split preparation for all procedures has been shown to give superior outcomes, and the longer the wait from consumption of the purgative to procedure correlates closely with worse cleansing. A national survey in the UK 2018 demonstrated that only 7% of NHS Trusts in the UK used split preparation for morning procedures, with the rest offering day before preparation. The aim of this study was to re-evaluate timing of bowel preparation five years after this first survey of practice in the UK.

Methods

All NHS Trusts that responded to the 2018 and at that time used day before preparation for morning procedure were contacted by telephone or email. Details on timing of preparation, type of preparation and patient education regarding preparation were requested. Descriptive analyses were conducted with the proportions of different practices calculated.

Results

70 Trusts were contacted. 27 (39%) of Trusts responded. 5 (19%) Trusts had changed practice and utilised split preparation for all procedures. 23 (85%) of Trusts utilised split bowel preparation for afternoon procedures, with the remaining recommending patients to prepare for afternoon procedures the day prior. Most Trusts used 2 litre polyethylene glycol with ascorbate 7/27 (59%). 19/27 (70%) used direct nurse lead patient education on bowel preparation, with 11/27 (41%) offering it to all patients. 15% of trusts provided patients with an educational video on how to take their bowel preparation

Conclusion

Split bowel preparation usage for morning procedures has increased in UK NHS Trusts. However, most Trusts that responded do not recommend patients to take bowel preparation at timings that will give the best opportunity of adequate cleansing. Although, patients need to wake early for morning split bowel preparation, this may be worth the price of the improved bowel preparation.