A protocol for antegrade bowel preparation in patients with defunctioning loop ileostomy

Abstract

Aim: Patients with loop ileostomies undergoing cancer surveillance or preparing for ileostomy reversal often experience colonoscopy with inadequate bowel prep such that the procedure is challenging and confidence in the result may be impossible. We describe an effective protocol for antegrade administration of bowel preparation via the loop ileostomy mucus fistula limb. Method(s): We present an easy to follow step-by- step method for clinicians to follow for effective bowel preparation. Result(s): Antegrade bowel prep using Gastrografin (Diatrizoate Meglumine and Diatrizoate Sodium Solution) is possible using a Foley catheter in the distal ileostomy limb, in addition to phosphate enema, resulting in good views of both right and left colon. Conclusion(s): Existing practice is generally limited to phosphate enema administration and irrigation during the procedure. Poor views, particularly of the right colon are often accepted on the basis full colonoscopy will take place following restoration of continuity. The benefits of this approach are the quality of the bowel prep that ensures even small lesions may be detected in the diverted colon, and the confidence for both patient and surgeon that the colon is healthy, whether or not the loop ileostomy can be closed.