Abstract
AimsConstipation associated with opioid therapy for chronic pain may negatively impact colonoscopy success. This retrospective, observational study using administrative data and electronic medical records evaluated the impact of opioid use on colonoscopy outcomes.Methods and ResultsProcedural codes were used to identify patients who had a screening colonoscopy at two Henry Ford Health System centers (January 2015–December 2016). All patients had completed a standard uniform bowel preparation protocol. Medication orders and filled prescriptions were used to identify patients with a history of opioid use during the 28 days preprocedure (exposed) and a matched random sample of presumptive opioid nonusers (unexposed). Electronic medical records were reviewed for colonoscopy procedure data and outcomes.The exposed and unexposed groups included 964 and 1054 patients, respectively. Inadequate bowel preparation was significantly more common in the exposed versus unexposed group (18.5% vs 12.7%; P < 0.001). In the exposed and unexposed groups, 97.1 and 98.0% of colonoscopy procedures were completed, respectively (P = nonsignificant). Total procedure time was slightly increased for the exposed versus unexposed group (23.8 vs 22.5 min; P = 0.039). Polyp identification and cancer diagnosis were similar between groups. Prolonged sedation occurred in three patients in the exposed group and none in the unexposed group. Procedural complications were rare, but the incidence was significantly greater in the exposed versus unexposed group (1.3% vs 0.2%; P < 0.01).ConclusionsOpioid exposure was associated with significant reductions in the quality of preprocedure bowel preparation and an increased risk of complications in patients undergoing colonoscopy.
Highlights
Colonoscopy is recommended in current guidance from the US Multi-Society Task Force on Colorectal Cancer as a first-tier screening test for colorectal cancer (CRC)[1] and is the most commonly used test to screen for CRC.[2]
The aim of the current study was to compare colonoscopy outcomes between patients who were opioid users within a relatively close time frame to the colonoscopy procedure and those who had not been exposed to opioids; patients with evidence of current opioid exposure within the month prior to the procedure were selected for inclusion in the analysis, while those with only historical exposure were excluded
These selection criteria for opioid exposure were considered sufficient to have an impact on gastrointestinal motility, while the criteria for unexposed patients likely provided sufficient time since the termination of opioid use to allow for complete washout of the opioid effect on motility and any corresponding effect on bowel preparation
Summary
Colonoscopy is recommended in current guidance from the US Multi-Society Task Force on Colorectal Cancer as a first-tier screening test for colorectal cancer (CRC)[1] and is the most commonly used test to screen for CRC.[2]. Along with contributing to missed adenomas, inadequate bowel preparation may be associated with an increased risk of procedure-related complications,[11] as well as increased costs, increased procedure times, canceled procedures, and the need for repeat examination.[12]
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Schedule a callMore From: JGH open : an open access journal of gastroenterology and hepatology
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