S954 Experiences With Bowel Preparation for Colonoscopy in Crohn’s Disease

Abstract

Introduction: Patients with inflammatory bowel disease (IBD) require frequent colonoscopies. Crohn’s disease (CD) may present unique challenges to bowel prep for colonoscopy due to the presence of strictures, fistulas, or prior bowel resections. Little is known about CD patients’ experiences with bowel preps. The purpose of this study was to develop an in-depth understanding of experiences with bowel prep for colonoscopy in CD, from the perspectives of patients and providers. Methods: We used a mixed methods approach, inviting CD patients ≥ 18 years of age scheduled for outpatient colonoscopy at two medical centers between July 2021-January 2022, and gastroenterologists, to participate in a survey and focus groups. Domains that were covered included experiences with existing bowel preps, including barriers to tolerance, and perceptions about ideal preps. Results: A total of 144 patients completed the survey and 7 participated in focus groups, with 50% between 18-39 years of age, 56% female, 80% Caucasian, and 65% reporting good/excellent health status. CD phenotypes included 32% with strictures, 20% with fistulas, 35% with prior bowel surgeries, and 34% with active disease. Reported challenges to bowel preps included the inability to eat, volume of liquid required, and disruptions to work and sleep. Ideal preps were described as lower volume, more palaTable, and without the need to fast. Worry about the prep was one of the leading reasons that patients delayed their colonoscopies. Despite these challenges, 91% of patients would undergo colonoscopy again if recommended by their physician. Six gastroenterologists participated in the study. Volume, taste, and safety concerns were reported as limitations to currently-available preps. All agreed that, if available, they would favor a prep that was tested in CD patients. Barriers to optimizing colonoscopy bowel prep for CD patients included limited knowledge about ideal volume required, lack of standardization of dietary modifications, and lack of bowel prep quality scoring methods. Conclusion: Bowel preparation is perceived as the most difficult part of undergoing colonoscopy among CD patients with worry about the prep as one of the leading causes of delaying colonoscopies. Given that CD patients may have altered anatomy due to their disease phenotypes and require frequent colonoscopies, future studies are needed to determine the optimal prep formulation, volume, and prep quality scoring methods for patients with CD.