Roel Bogie

Optimizing post-polypectomy surveillance: A practical guide for the endoscopist

respectively. 43 Next, it is important to carefully record anddocument thequality of bowel preparation, especially when insufficient bowel preparation is the reason to stop. Endoscopists may consider reporting the suspected reasons for failure of bowel preparation, e.g. failure to follow split-dose instructions, delay of the procedure or comorbidity. Understanding such factors will provide targeted solutions, such as better communication with patients and logistical improvements.

Table 7.2: Comparison of most frequently applied bowel preparation scales.

Scale

Feature

Aronchick

Ottawa

Boston

Splitting in segments After cleaning by endoscopist Total score

No

Yes (3 parts)

Yes (3 parts)

No

No

Yes (washing, suctioning)

1-5 (excellent to inadequate)

0-14 (excellent to inadequate)

0-9 (inadequate to excellent) Splitting colon into: Right colon: cecum – ascending colon; Transverse colon: hepatic flexure – sphlenic flexure; Left colon: descending colon – rectum. Scoring for each section: 0: unprepared colon segment with mucosa not seen because of solid stool that cannot be cleared; 1: portion of mucosa of the colon segment seen, but other areas of the colon segment are not well seen because of staining, residual stool, and/or opaque liquid; 2: minor amount of residual staining, small fragments of stool, and/or opaque liquid, but mucosa of colon segment is seen well; 3: entire colonic mucosa, colon segment seen well, with no residual staining, small fragments of stool, or opaque liquid. Total: Sum of scores for each section.

Scoring system

Excellent: small volume of clear liquid or ≥95% of surface seen; Good: large volume of clear liquid covering 5-25% of the surface but ≥90% of surface seen; Fair: some semi-solid stool that could be suctioned or washed away but ≥90% of surface seen; Poor: semi-solid stool that could not be suctioned or washed away and <90% of surface seen; Inadequate: repreparation needed.

Part A: Splitting colon into: Right colon (R): cecum – ascending colon; Mid colon (M): transverse – descending colon; Rectosigmoid colon (R-S): rectosigmoid. Scoring for each section: - 0 (excellent): perfect - 1 - 2 (fair): necessary to suction liquid stool - 3 (poor): necessary to wash and suction - 4 Part B: Fluid quantity of whole colon: - 0: no fluid - 1: moderate fluid - 2: lots of fluid Total: Score A + score B (sum of scores for each section)

7

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