Discontinuation of Non-Colonoscopy Related Suppositories Before Colonoscopy
Non-colonoscopy related suppositories should be discontinued at least 2 hours before a colonoscopy procedure, following the same guidelines as other clear liquids and bowel preparation agents. 1
Rationale for the 2-Hour Rule
The timing recommendation is based on several key factors:
American Society of Anesthesiologists (ASA) Guidelines: The 2023 ASA updated practice guidelines state that patients may consume clear liquids up to 2 hours before anesthesia or procedural sedation 1. This applies to suppositories as well, which are considered similar to clear liquids in terms of gastric emptying.
Gastric Emptying Considerations: Studies have shown that the rate of gastric emptying of bowel preparations and other clear liquids is similar, with no excess gastric volumes when following the 2-hour cutoff rule 1.
Optimal Bowel Preparation Timing: The US Multi-Society Task Force on Colorectal Cancer strongly recommends that all bowel preparation agents be completed at least 2 hours before the procedure start time 1.
Special Considerations
Types of Suppositories
Different types of suppositories may have different considerations:
Bisacodyl suppositories: Often used as part of bowel preparation regimens 2, 3. When used for this purpose, they should be administered according to the bowel preparation protocol.
Medication-containing suppositories: For non-colonoscopy related suppositories (such as those containing medications for pain, hemorrhoids, or other conditions), the same 2-hour rule applies.
Patient-Specific Factors
Certain patient conditions may require additional precautions:
Patients with GI disorders: Those with significant uncontrolled reflux disease, hiatal hernia, Zenker diverticulum, achalasia, stricture, previous gastric surgery, gastroparesis, or diabetes mellitus may require individualized timing considerations 1.
Patients on GLP-1 receptor agonists: These medications delay gastric emptying and may affect the timing. The ASA advises stopping these agents 1-7 days before an elective procedure 1.
Practical Implementation
Instruct patients clearly: Provide both verbal and written instructions about stopping suppositories at least 2 hours before the procedure 1.
Coordinate with medication schedules: If the suppository is medically necessary, work with the patient to adjust the timing of administration to maintain therapeutic effect while adhering to the 2-hour cutoff.
Document compliance: Ask patients about suppository use during the pre-procedure assessment.
Potential Complications of Non-Compliance
Failure to follow the 2-hour rule could potentially lead to:
Aspiration risk: Though studies show minimal risk when following the 2-hour guideline 1.
Procedure delays: If there are concerns about recent suppository use, the procedure might be delayed.
Interference with bowel preparation quality: Some suppositories might affect the quality of bowel preparation if used too close to the procedure time.
Common Pitfalls to Avoid
Assuming all suppositories are part of bowel preparation: Clearly distinguish between suppositories used for bowel preparation and those used for other medical purposes.
Overly restrictive timing: Requiring discontinuation more than 2 hours before the procedure is not evidence-based and may unnecessarily interfere with patient comfort or medical treatment.
Failing to communicate clearly: Ensure patients understand that the 2-hour rule applies to all rectal medications, not just oral intake.
By following these evidence-based guidelines, healthcare providers can ensure patient safety while maintaining optimal conditions for colonoscopy procedures.