Tag Archives: Boston Bowel Preparation Score

How Good is Your Prep?

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There are a lot of articles that have been published regarding bowel preparations prior to colonoscopy, especially in adults. One of the key advances has been split-prep dosing, which is not utilized much in the pediatric age group.

Nevertheless, a recent pediatric study (S Kumar et al. JPGN 2021; 73: 325-328. Inadequate Bowel Preparation in Pediatric Colonoscopy—Prospective Study of Potential Causes) shows that inadequate bowel preparation in their prospective cohort (n=334) was less prevalent than that noted from typical adult data. Their bowel preparation assessmetn was based on Boston Bowel Preparation Scale (BBPS).

Key finding: Inadequate bowel preparation (IBP) was noted in 12.8% (41/321); there were no age, gender, obesity, race, or insurance type associated with IBP. (IBP was defined by BBPS <5)

Their preparation instructions:

  • If <25 kg, “119 g of PEG 3350 mixed in 32 oz of sport drink” and then “additional 32 oz of a sports drink without PEG 3350”
  • If 26-49 kg, “238 g of PEG 3350 mixed with 64 ounces of fluids” and then “additional 64 oz of a sports drink without PEG 3350”
  • If >50 kg, “238 g of PEG 3350 mixed with 64 ounces of fluids” and then “64 ounces of a sports drink and four bisacodyl tablets”

My take: If you are seeing a high rate of IBP, the prep instructions in this study could be replicated (given their good results), split preps could be given for teens, and better instructions (visual aids) could be needed.

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Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

Low Fiber Diet During Bowel Prep

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A recent prospective, randomized trial (A Mytyk et al. JPGN 2018; 66: 720-24) compared a low fiber diet with a clear liquid diet during a polyethyylene glycol prep prior to colonoscopy. N=184, Median age 15 yrs (range 6-18 yrs).

Low fiber diet included milk, dairy products, some soups, bread and rolls, sandwiches, meat, fish, eggs, pasta, and honey.

Children in both groups were asked to fast for a minimum of 6 hours prior to colonoscopy and their bowel prep was assessed with the Boston Bowel Preparation Scale (BBPS). Bowel prep consisted of PEG 4000 with electrolytes dosed at 66 mL/kg to max of 4 liters.

Key findings:

  • There was no significant difference in BBPS between the two groups
  • Overall, 95.4% of patients had good bowel cleanness (BBPS ≥5)

My take: This study indicates that with a good volume of bowel prep, a less-rigorous diet change may be effective for a cleanout.

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

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“Show Don’t Tell” –Colonoscopy Prep Instructions

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A recent study, summarized in this link– Gastroenterology and Endoscopy News, indicates that providing an 11 minute video with colonoscopy prep instructions was more effective than written instructions.  Not only were the cleanouts better, but this resulted in better outcomes including higher adenoma detection rate and higher rates of completed colonosocpy.

Here’s an excerpt:

Dr. Bearelly and his colleagues randomized 298 individuals scheduled for screening colonoscopy to receive either the practice’s usual written instructions, or to receive the paper handout plus an instructional video (right). The 11-minute video—burned on a disk —covers the same instructions as the written materials, but in an interactive format that depicts a typical patient asking questions of one of the practice’s doctors.

The quality of bowel preparation between the two groups differed significantly (P=0.0098). Cecal intubation was 96% in the intervention group compared with 89% in the control group, and the adenoma detection rate was 53% and 42% in the two groups, respectively.

Patients in the intervention group had a Boston Bowel Preparation Score (BBPS) of 6.99±1.87, whereas those in the control group had a score of 6.43±2.54, although the difference was not statistically significant. A BBPS of 6, with a minimum of 2 in each segment, was considered adequate.

Take-home message:  Video instructions for colonoscopy are worthwhile.  In pediatrics, variability in cleanout regimens is a limiting factor.

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