Low-Residue Diet Bowel Preparation in a Veteran Population: Satisfaction, Compliance, and Risk Factors for Inadequate Bowel Preparation

Abstract

Introduction: Bowel preparation with a low-residue diet (LRD) has demonstrated higher patient satisfaction and similar polyp detection rates compared to the conventional clear liquid diet. However, there is very limited experience with LRD in the veteran population, in which conditions associated with poor bowel preparation are more prevalent than in the general population. Our VA facility recently implemented a LRD for bowel preparation. In this study, we examined veteran satisfaction and compliance with the LRD and factors associated with inadequate bowel preparation. Methods: To examine patient satisfaction and compliance, we administered an anonymous questionnaire to patients undergoing outpatient colonoscopy at the Manhattan VA Medical Center from 3/2018-5/2018. Descriptive statistics were calculated. To examine factors associated with inadequate bowel preparation, we conducted a chart review of a subset of outpatient colonoscopies between 2/2017-4/2018. Using a combination of computerized and manual data extraction, we obtained information on demographics, medical risk factors, medications, endoscopic findings, and histologic results. We assessed potential predictors of inadequate bowel preparation using the chi-squared test and t-test. Results: We included 259 patients in the chart review study and 97 patients in the questionnaire study. Questionnaire responses showed high satisfaction with LRD bowel preparation: 87.6% of patients were willing to repeat the bowel preparation, 87.6% found the process easy or acceptable, and 43.2% had no symptoms during preparation (Table 1). Patients also had high self-reported compliance with LRD (89.6%). Patients in the chart review study were 92.3% male with a mean age of 64 years. An adequate Boston Bowel Preparation Scale score ≥2 in each colonic segment was achieved in 92.3% of procedures. The following factors were associated with inadequate bowel preparation: diabetes (p=0.01), higher BMI (p<0.01), and use of opioid medication (p=0.01, Table 2). Older age, race, and smoking status were not significantly associated with poor bowel preparation. Conclusion: In a VA population using the LRD for bowel preparation, there was high satisfaction and compliance. The quality of bowel preparation was high. Diabetes, higher BMI, and use of opioid medication were predictors of inadequate bowel preparation with the LRD. Targeted interventions to improve bowel preparation in these patients should be considered.313_A Figure 1 No Caption available.313_B Figure 2 No Caption available.