NPO Status Prior to Colonoscopy Evidence-based Synthesis Program Table 1. Study Characteristics Patient Characteristics Study/Region/ Inclusion/Exclusion Criteria (expressed in means unless NPO status groups Risk of Bias Funding Source otherwise noted) Abdul-Baki Inclusion Criteria: ambulatory N=382 NPO status group 1a: Split-dose PEG-E with 2L For RCTs 200813 outpatient adults undergoing consumed evening before and 2L day of Sequence generation: elective colonoscopies Age (yr): 55 colonoscopy (to be completed 2 hours before adequate Location: Gender (Male %): ~61 the procedure) + tegaserod 6 mg pills (1 tablet Lebanon Exclusion Criteria: patients Race (%): NR night before and one 2.5 hours before Allocation concealment: <18 years of age, presence of BMI: NR procedure); (n=92) adequate Study design: severe renal impairment, NPO status group 1b: matched placebo (n=107) RCT (4-way) moderate or severe hepatic Co-existing conditions (%) Blinding: yes, impairment, a history of bowel Inflammatory bowel disease: 4 Patients allowed regular diet until 6 pm day endoscopist, participant Funding source: obstruction, known allergies before colonoscopy and water until procedure (tegaserod) Industry to PEG or tegaserod Indications for colonoscopy time (%) Incomplete outcome data: Screening: 25 NPO status group 2a: PEG-E consumed no Abdominal pain: 24 evening before colonoscopy + tegaserod 6 mg Changes in bowel habits: 15 pills (1 tablet night before and one 1.5 hours Selective outcome Rectal bleeding: 21 before procedure) (n=94) reporting: no Anemia: 4 NPO status group 2b: matched placebo (n=89) Surveillance of colon Risk of bias: Low cancer/polyps: 7 Patients allowed liquid diet until 6 pm day before colonoscopy and water until procedure time Sedation: conscious Study withdrawals: none 50 NPO Status Prior to Colonoscopy Evidence-based Synthesis Program Patient Characteristics Study/Region/ Inclusion/Exclusion Criteria (expressed in means unless NPO status groups Risk of Bias Funding Source otherwise noted) Aoun 200514 Inclusion Criteria: ambulatory N=141 NPO status group 1: PEG-E split-dose - 2L For RCTs outpatient adults undergoing Age (yr): 57 (range 20-84) night prior and 2L morning; finish morning dose Sequence generation: Location: elective colonoscopies Gender (Male %): 57 at least 1.5 hours before procedure, regular diet adequate Lebanon Race (%): NR until 6:30 pm day before colonoscopy; water Exclusion Criteria: patients BMI: NR allowed up to colonoscopy (n=68) Allocation concealment: Study design: <18 years of age, presence of adequate RCT a severe illness (cardiac, Co-existing conditions (%) NPO status group 2: 4L PEG-E - 6:00 to 10:00 renal, or Inflammatory bowel disease: 4 pm day before procedure; liquid diet only day Blinding: yes, Funding source: metabolic), active alcoholism, before colonoscopy; only water after midnight endoscopists None reported drug addiction, major Indications for colonoscopy (n=73) psychiatric illness, known (%) Incomplete outcome data: allergies to PEG Abdominal pain: 28 Sedation: conscious no Screening: 25 Changes in bowel habits: 15 Study withdrawals: none Selective outcome Rectal bleeding: 14 reporting: no Anemia: 4 Family history of colorectal Risk of bias: :Low cancer: <1 Arya 201315 Inclusion Criteria: patients N=147, 14 excluded. 133 NPO status group 1: Rapid-prep ShudhTM colon For RCTs 21–70 years of age referred completed study cleanse (SCC) - patients start SCC around 6 Sequence generation: Location: USA for colonoscopy with good (demographics based on 133) am on morning of colonoscopy drinking 240- adequate general physical status 480 ml every 5 minutes (total 1-2 L); last glass Study design: (American Society of Age (yr): 44 ≥2 hours prior to procedure (n=74) Allocation concealment: RCT Anesthesiologists [ASA] class Gender (Male %): 38 Day prior to colonoscopy, patients instructed to unclear 1 or 2) Race (%): white 88; black 8 eat light breakfast up to 12 pm and then stay on Funding source: BMI: NR clear liquids Blinding: yes, None reported Exclusion Criteria: history of endoscopists chronic heart, liver, or kidney Co-existing conditions (%): NR NPO status group 2: Half-Lytely® colon prep disease; hypertension, (HCP) - 2 bisacodyl delayed-release tablets Incomplete outcome data: diabetes mellitus, arthritis Indications for colonoscopy taken at 1 pm; patients start drinking 2L solution yes (spine, shoulder, hip and (%) after a bowel movement or around 7 pm if no knee joints) severe Screening: 42 bowel activity occurred (n=73) Selective outcome constipation, or concurrent Rectal bleeding: 20 Patients stay on clear liquids entire day prior to reporting: no severe diarrhea, ileus, Mild constipation: 19 colonoscopy suspected intestinal Abdominal pain: 11 Risk of bias: Moderate obstruction, bowel Anemia: 3 Sedation: NR perforation, previous Mild diarrhea: 3 gastrointestinal tract surgery, Study withdrawals: 10% (n=14) excluded prior gastro-paresis, toxic colitis, to procedure (no-shows) ulcerative colitis, pregnancy, and lactation 51 NPO Status Prior to Colonoscopy Evidence-based Synthesis Program Patient Characteristics Study/Region/ Inclusion/Exclusion Criteria (expressed in means unless NPO status groups Risk of Bias Funding Source otherwise noted) 16 Athreya 2011 Inclusion Criteria: elective N=325 NPO status group 1: PM group- 2 sachets For RCTs colonoscopy patients PicoPrep-3™ day prior and 3rd sachet 6 to 7 am Sequence generation: not Location: Age (yr): 57 (24-92) on day of procedure; solids ceased after 8 am applicable Australia Exclusion Criteria: prior Gender (Male %): 50 day prior; clear fluids continued until 4 hrs prior surgical resection, patients Race (%): NR to procedure (n=150) Allocation concealment: Study design: who had taken GlycoPrep™ BMI: NR inadequate (alteration) CCT (polyethylene glycol NPO status group 2: AM group- 3 sachets electrolyte) as the bowel Co-existing conditions (%): NR PicoPrep-3™ day prior to procedure; solids Blinding: Investigator Funding source: preparation or those ceased after 8 am day prior; clear fluids None reported administered a Fleet™ Indications for colonoscopy continued until midnight prior to procedure Incomplete outcome data: enema on arrival, and failure (%) (n=175) no to achieve caecal intubation Symptoms (not specified): 36 Screening: 35 Sedation: conscious Selective outcome Family history: 21 reporting: no Family history & symptoms: 8 Study withdrawals: none Risk of bias: High 17 Barclay 2004 Inclusion Criteria: ambulatory N=303 randomized, 47 NPO status group 1: 3-dose regimen; aqueous For RCTs outpatient adults undergoing excluded. 256 completed study NaP day before procedure; 2nd dose 5 hours Sequence generation: Location: USA elective colonoscopies (demographics based on 256) later; 3rd dose 3 hours before scheduled time of adequate procedure (n=131) Study design: Exclusion Criteria: patients Age (yr): medians 57-59 Allocation concealment: RCT <18 years of age, congestive Gender (Male %): 45 NPO status group 2: 2-dose regimen (n=125) not reported heart failure, renal Race (%): NR a) morning colonoscopy; aqueous NaP day Funding source: insufficiency (creatinine > 120 BMI: NR before procedure; 2nd dose 5 hours later (same Blinding: yes, Industry lmol/L), ascites day) endoscopists Co-existing conditions (%) b) afternoon colonoscopy; aqueous NaP day Diabetes: 9 before procedure; 2nd dose 5 hours before Incomplete outcome data: On diuretics: 11 scheduled time of procedure yes Indications for colonoscopy All patients: clear fluid diet for 24 hours before Selective outcome (%) colonoscopy; instructed to drink 3.8L of reporting: no Rectal bleeding/+ FOBT: 29 commercially available carbohydrate-electrolyte Abdominal pain: 25 solution during preparation period Risk of bias: Moderate Screening: 23 Changes in bowel habits: 20 Sedation: NR Study withdrawals: 18% (n=47) excluded prior to procedure 52 NPO Status Prior to Colonoscopy Evidence-based Synthesis Program Patient Characteristics Study/Region/ Inclusion/Exclusion Criteria (expressed in means unless NPO status groups Risk of Bias Funding Source otherwise noted) Bryant 201318 Inclusion Criteria: mostly N=1,785 NPO status group 1: Afternoon colonoscopies; 1) Study design: outpatients (89%) undergoing prep to procedure interval 5-7.5 hrs (n=768) retrospective Location: colonoscopy Age (yr): <55 34%; ≥55 66% a) 2L PEG at 5-7 pm day before + 2L PEG Australia Gender (Male %): 53 before 8 am day of colonoscopy 2) Population: consecutive Exclusion Criteria: patients Race (%): NR b) 2 sachets sodium picosulphate at 1 pm and 5 Study design: with a prior history of large BMI: NR pm day before + 1L PEG before 8 am day of 3) Analysis of findings Retrospective bowel resection, colonoscopy a. Was the method for observational colonoscopies where cecal Co-existing conditions (%): NR handling missing data intubation could not be NPO status group 2: Morning colonoscopies; reported and appropriate? Funding source: achieved due to an Indications for colonoscopy prep to procedure interval 8.5-17 h; (n=1,017) appears to be no missing None reported obstructing lesion, and (%) a) 4L PEG between 2 pm and 7 pm day before data colonoscopy reports which Anemia/Rectal bleeding: 37 colonoscopy did not report on bowel Screening: 34 b) 2 sachets sodium picosulphate at 9 am and 1 b. Were the preparation Altered bowel habit: 12 pm day before + 1L PEG at 4 pm characteristics of the Colitis: 6 different NPO groups Other: 11 All patients: low-residue diet 2 days before and similar? unclear only clear fluids 1 day before