923 ADJUSTED COMPARISON OF COMMERCIAL BOWEL PREPARATIONS BASED ON INADEQUACY OF BOWEL PREPARATION IN OUTPATIENT SETTINGS

Abstract

Adequate bowel preparation is important for effective colonoscopic examination. Although limited research has identified commercial bowel preparations (CBP) associated with inadequate bowel preparation (IBP) it does not adjust for multiple known risk factors associated with IBP. In this study, after adjusting for many factors previously identified to affect IBP, various commercial bowel preparations are compared with each other. After obtaining permission from Institutional Review Board, all ambulatory colonoscopies performed within the Cleveland Clinic system (Jan 2011-Aug 2017) were reviewed. Risk factors previously noted to affect IBP were identified: age, gender, race, body mass index, payor status, Primary spoken language (English v. other), diabetes, cirrhosis, dementia, stroke, constipation, coronary artery disease, heart failure, opiate use, timing of colonoscopy (AM v. PM, day of the week, month of the year), colonoscopy location, endoscopist specialty, distance from home to colonoscopy location, individual providers, and when CBP was picked up by patient. Differences in IBP by specific CBP--SUPREP (Su), OsmoPrep (Os), PREPOPIK (Pr), NuLYTELY (Nu), GoLYTELY (Go), CoLyte (Co), MoviPrep (Mo), GaviLyte (Ga), HalfLytely (Ha), and TriLyte (Tr)--were calculated and significance was assessed using chi-square analysis. Multivariate analysis was performed. N=140,912 colonoscopies were reviewed. Overall IBP was noted 19.5% of colonoscopies. Bar-graph demonstrating IBP by various CBPs is noted (Figure 1). After adjusting for risk factors of ABP. Compared to Su, Os (OR=2.68), Pr (OR=1.94), Go (OR=2.09), Co (OR=1.94), Mo (OR=2.22), Ga (OR=1.88), and Ha (OR=3.52) had significantly increased risk of IBP. Next, compared to Nu, Os (OR=2.46), Pr (OR=1.78), Co (OR=1.78), Mo (OR=2.04), Ga (OR=1.73), Ha (OR=3.23) had significantly increased risk of IBP. Further, compared to Pr, Mo (OR=1.15) and Ha (OR=1.68) had increased odds of IBP. Compared to Go, Mo (OR=1.06) and Ha (OR=1.68) had increased risk of IBP. Only comparisons, where p<0.05 are listed above. Refer to Table 1 complete set comparisons. Adjusting for many patient characteristics, procedural factors, and risk factors associated with IBP, CBPs can be arranged in the following order from lowest to highest rates of IBP: (Su and Nu comparable efficacy), Os, Pr, (Co & Go have comparable efficacy), Ga, Tr, and Ha. While further evaluation is necessary to evaluate the efficacy of preparations used infrequently, this large study on bowel preparations has significant impact with respect to improving adenoma detection rate (as IBP worsens ABP), and prevent recurrent IBP--along with the significant patient discomfort and financial burden associated with it.View Large Image Figure ViewerDownload Hi-res image Download (PPT)