Tadd K. Hiatt, MD
Adequate bowel preparation is necessary for all endoscopic procedures. Ease of patient administration and adequate patient compliance with the prep instructions are important to achieve successful bowel cleansing. This chapter will provide an overview of the various bowel preparatory regimens utilized in current gastrointestinal (GI) practice.
Fasting prior to upper endoscopy is required for nearly all elective cases. Relative contraindications for upper endoscopy include known esophageal, gastric, or duodenal perforation; severe strictures and tortuosity of the esophagus; and large diverticula involving the cervical esophagus.
Preparation for upper endoscopy consists of nothing by mouth 6 hours before the procedure. Occasionally when a large blood clot or bezoar is located in the stomach, a promotility agent such as erythromycin 250 mg IV may be given in advance of the procedure in an attempt to clear the gastric contents.1 Large-bore orogastric or nasogastric lavage may also be beneficial in those situations.2
The preparation for the performance of physiologic studies also depends upon the indication for the procedure. Individuals undergoing 24-hour pH studies may need to discontinue all acid-suppressive medicines or may need to be tested while on their standard dose. Subjects should refrain from taking motility-altering agents such as narcotics prior to undergoing esophageal, gastric, or small bowel motility studies. Most physiologic studies require that the patient take nothing by mouth 6 hours before the procedure.
There are no absolute contraindications to the performance of motility studies. Relative contraindications include patient anxiety and an inability to cooperate with the procedure.
The preparation for capsule endoscopy is similar to upper endoscopy. Individuals are typically instructed to take nothing by mouth 6 hours before the procedure. However, protocols vary from institution to institution, with many recommending that colonoscopy bowel preparation be utilized to clear the small bowel contents and improve visualization.
Absolute contraindications to capsule endoscopy include a high-grade stricture or obstruction. Severe motility disorders, such as scleroderma, are relative contraindications. In selected patients where luminal pathology is suspected, a patency capsule is often utilized to ensure safe passage to the colon.3
Although video capsule endoscopy is theoretically able to visualize the entire small intestine, push enteroscopy or deep enteroscopy (single-balloon enteroscopy or double-balloon enteroscopy) is required to obtain biopsy specimens or perform therapeutic interventions in the area between the ampulla of Vater and the ileocecal valve.
As far as preparation for these procedures is concerned, a fasting-only approach is typically adequate for a push enteroscopy or lesions targeted in the proximal to mid-jejunum. Deep enteroscopy, however, requires a full bowel prep.4