Predictor Of Poor Bowel Preparation Research Articles

Effect of bowel preparation volume in inpatient colonoscopy. Results of a prospective, randomized, comparative pilot study

BackgroundInpatient status has been shown to be a predictor of poor bowel preparation for colonoscopy; however, the optimal bowel preparation regimen for hospitalized patients is unknown. Our aim was to compare the efficacy of bowel preparation volume size in hospitalized patients undergoing inpatient colonoscopy.MethodsThis prospective, single blinded (endoscopist), randomized controlled trial was conducted as a pilot study at a tertiary referral medical center. Hospitalized patients undergoing inpatient colonoscopy were assigned randomly to receive a high, medium, or low-volume preparation. Data collection included colon preparation quality, based on the Boston Bowel Preparation Scale, and a questionnaire given to all subjects evaluating the ability to completely finish bowel preparation and adverse effects (unpleasant taste, nausea, and vomiting).ResultsTwenty-five colonoscopies were performed in 25 subjects. Patients who received low-volume preparation averaged a higher mean total BBPS (7.4, SD 1.62), in comparison to patients who received high-volume (7.0, SD 1.41) and medium-volume prep (6.9, SD 1.55), P = 0.77. When evaluating taste a higher score meant worse taste. The low-volume group scored unpleasant taste as 0.6 (0.74), while the high-volume group gave unpleasant taste a score of 2.2 (0.97) and the medium-volume group gave a score of 2.1 (1.36), P < 0.01.ConclusionIn this pilot study we found that low-volume colon preparation may be preferred in the inpatient setting due its better rate of tolerability and comparable bowel cleanliness when compared to larger volume preparation, although we cannot overreach any definitive conclusion. Further more robust studies are required to confirm these findings.Trial registrationThe Affect of Low-Volume Bowel Preparation for Hospitalized Patients Colonoscopies. Trial registration: NCT01978509 (terminated). Retrospectively registered on November 07, 2013.

165 Effect of Bowel Preparation Volume Size in Inpatient Colonoscopy. Results of a Prospective, Randomized, Comparative Pilot Study

INTRODUCTION: Inpatient status has been shown to be a predictor of poor bowel preparation for colonoscopy since these patients are usually older, less mobile, have more medical comorbidities, and often require emergent evaluation. Our aim was to compare the efficacy of bowel preparation volume size in hospitalized patients undergoing inpatient colonoscopy. METHODS: This prospective, single blinded (endoscopist), randomized controlled trial was IRB approved and conducted as a pilot study at a Tertiary Referral Medical Center between September 2013 and March 2019. Hospitalized patients aged 18 years or older undergoing inpatient colonoscopy were assigned randomly to receive a high-volume solution (GoLYTELY®, medium-volume solution (MoviPrep®) or a low-volume Prepopik® solution. Adverse effects including unpleasant taste, nausea, and vomiting were scored through a questionnaire using a five-point scale ranging from 0 (no symptoms) to 4 (severe symptoms). Boston Bowel Prep Score (BBPS) was used to evaluate colon cleanliness. Descriptive statistics are presented as mean values ± standard deviation (SD), and P-values were calculated using Chi-Square and Kruskal-Wallis tests. RESULTS: Twenty-five colonoscopies were performed in 25 subjects. Mean age was 66.6 years (16.34) and 68% were male (Table 1). Indications for colonoscopy varied and are shown in Table 1. Total BBPS scores were higher in patients who received Prepopik®, 7.4 (1.62), than GoLYTELY® 6.6 (2.19) or MoviPrep® 6.9 (1.55), P = 0.66 (Figure 1). There was no difference in BBPS in right, transverse, or left colon scores. Regarding tolerance to preparation, 100% of the Prepopik® group reported completing the bowel preparation compared to 77.8% of the GoLYTELY® group and 66.4% of the MoviPrep® group (P = 0.24). The Prepopik® group reported fewer side effects than GoLYTELY®/MoviPrep® groups (Table 2). CONCLUSION: In this pilot study, a low-volume colon preparation demonstrated at least equivalent quality of bowel preparation measured by BBPS in comparison with traditional higher volume regimens, with less adverse effects, and better compliance for cleansing completion. This study suggests small volume purgative may lead to better patient compliance and therefore, better bowel preparation in the inpatient setting. The lack of statistical significance is likely due to a type II error. Further more robust studies are required to confirm these findings.

The Dirty Side of Colonoscopy: Predictors of Poor Bowel Preparation and Novel Approaches to Overcome the Shortcomings

The Dirty Side of Colonoscopy: Predictors of Poor Bowel Preparation and Novel Approaches to Overcome the Shortcomings

Constipation, fiber intake and non-compliance contribute to inadequate colonoscopy bowel preparation: a prospective cohort study.

Adequate bowel preparation is important for colonoscopy. Currently available evidence on the determinants of poor bowel preparation is largely derived from studies in Western countries. We aimed to identify the risk factors for inadequate bowel preparation for colonoscopy in the Chinese population. In this single-center study, patients admitted to the Outpatient Department between March 2013 and December 2015 and had indications for colonoscopy were prospectively enrolled. Questionnaires were administered to the patients. Their characteristics and procedure-related parameters such as procedure time were recorded. Bowel preparation was assessed using Boston bowel preparation scale score. A total of 409 patients with a mean age of 48.8 ± 12.9 years were enrolled in the study, 60.9% of whom were men. On univariate analysis, poor educational level (P = 0.020), chronic constipation (P = 0.001), taking no physical exercise after medication (P < 0.001), a high-fiber diet during the 24-h period immediately preceding the colonoscopy (P < 0.001), incomplete intake of medication (P < 0.001), the passage of yellow or dark stools before colonoscopy (P < 0.001), waiting time (P = 0.001) and stool frequency after medication (P = 0.048) were significantly associated with inadequate bowel preparation. On multivariate analysis, chronic constipation [odds ratio (OR) 2.05, 95% confidence interval (CI) 1.31-3.23, P = 0.002], incomplete intake of the medication (OR 2.77, 95% CI 1.47-5.21, P = 0.002) and a high-fiber diet within 24 h before colonoscopy (OR 2.15, 95% CI 1.40-3.28, P < 0.001) were independent risk factors for inadequate bowel preparation. Chronic constipation, poor compliance with treatment and high-fiber diet were predictors of poor bowel preparation. Patients with these risk factors require more effective strategies for bowel preparation.

Age Is the Only Predictor of Poor Bowel Preparation in the Hospitalized Patient

We examine the impact of key variables on the likelihood of inpatient poor bowel preparation for colonoscopy. Records of inpatients that underwent colonoscopy at our institution between January 2010 and December 2011 were retrospectively extracted. Univariable and multivariable logistic regression models were fitted to assess the effect of clinical variables on the odds of poor preparation. Tested predictors included age; gender; use of narcotics; heavy medication burden; comorbidities; history of previous abdominal surgery; neurological disorder; product used for bowel preparation, whether or not the bowel regimen was given as split or standard dose; and time of endoscopy. Overall, 244 patients were assessed including 83 (34.0%, 95% CI: 28.1–39.9%) with poor bowel preparation. Cecal intubation was achieved in 81.1% of patients (95% CI: 76.2–86.0%). When stratified by quality of bowel preparation, cecal intubation was achieved in only 65.9% (95% CI: 60.0–71.9%) of patients with poor bowel preparation and 89.9% (95% CI: 86.1–93.7%) of patient with good bowel preparation. In multivariate logistic regression analysis, only advancing age was an independent predictor of poor bowel preparation (OR = 1.026, CI: 1.006 to 1.045, and p = 0.008). Age is the only independent predictor of poor bowel preparation amongst hospitalized patients.

Determinants of Bowel Preparation Quality and Its Association With Adenoma Detection

The predictors of poor bowel preparation in colorectal cancer screening participants have not been adequately studied, and the association between the quality of bowel preparation and adenoma detection has not been firmly established. This study examined the determinants of poor bowel preparation, and evaluated its relationship with adenoma detection.We included subjects aged between 50 and 70 years who received colonoscopy between 2008 and 2014 in a colorectal cancer screening program in Hong Kong. The quality of the bowel preparation was assessed by colonoscopists, and the factors associated with poor bowel cleansing were evaluated by a binary logistic regression analysis. A multivariate regression model was constructed to evaluate if poor bowel preparation was associated with detection of colorectal neoplasia.From 5470 screening participants (average age 57.7 years, SD 4.9), 1891 (34.6%) had poor or fair bowel preparation. The average cecal intubation time was 7.0 minutes (SD 5.4; range 1.22–36.9 minutes) and the average colonoscopy withdrawal time was 10.8 minutes (SD 6.9; range 6.0–107.0 minutes). Among all, 26.5% had colorectal neoplasia and 5.5% had advanced neoplasia. Older age (≥60 years; adjusted odds ratio [AOR] = 1.19–1.38, P = 0.02–0.04), male sex (AOR = 1.38, 95% confidence interval [CI] 1.19–1.60, P < 0.001), and current smoking (AOR = 1.41, 95% CI 1.14–1.75, P = 0.002) were significantly associated with poor/fair bowel preparation. Poorer cleansing resulted in significantly lower detection rate of neoplasia (AOR = 0.35–0.62) and advanced neoplasia (AOR = 0.36–0.50) irrespective of polyp size.Steps to improve proper procedures of bowel preparation are warranted, especially among subjects at risk of poor bowel preparation. Strategies should be implemented to improve bowel cleansing, which is now demonstrated as a definite quality indicator.

Quality of bowel cleansing in hospitalized patients undergoing colonoscopy: A multicentre prospective regional study

BackgroundQuality of bowel cleansing in hospitalized patients undergoing colonoscopy is often unsatisfactory. No study has investigated the inpatient or outpatient setting as cause of inadequate cleansing. AimsTo assess degree of bowel cleansing in inpatients and outpatients and to identify possible predictors of poor bowel preparation in the two populations. MethodsProspective multicentre study on consecutive colonoscopies in 25 regional endoscopy units. Univariate and multivariate analysis with odds ratio estimation were performed. ResultsData from 3276 colonoscopies were analyzed (2178 outpatients, 1098 inpatients). Incomplete colonoscopy due to inadequate cleansing was recorded in 369 patients (11.2%). There was no significant difference in bowel cleansing rates between in- and outpatients in both colonic segments. In the overall population, independent predictors of inadequate cleansing both at the level of right and left colon were: male gender (odds ratio, 1.20 [1.02–1.43] and 1.27 [1.05–1.53]), diabetes mellitus (odds ratio, 2.35 [1.68–3.29] and 2.12 [1.47–3.05]), chronic constipation (odds ratio, 1.60 [1.30–1.97] and 1.55 [1.23–1.94]), incomplete purge intake (odds ratio, 2.36 [1.90–2.94] and 2.11 [1.68–2.65]) and a runway time >12h (odds ratio, 3.36 [2.40–4.72] and 2.53 [1.74–3.67]). ConclusionsWe found no difference in the rate of inadequate bowel preparation between hospitalized patients and outpatients.

Tu1503 Quality of Bowel Cleansing in Hospitalized Patients Is Not Worse Than That of Outpatients Undergoing Colonoscopy: Results of a Multicenter Prospective Regional Study

Tu1503 Quality of Bowel Cleansing in Hospitalized Patients Is Not Worse Than That of Outpatients Undergoing Colonoscopy: Results of a Multicenter Prospective Regional Study Gianluca Rotondano*, Antonio Rispo, Maria E. Bottiglieri, Dario Bruzzese, Leonardo De Luca, Roberto Lamanda, Luigi Orsini, Giuseppe Galloro Gastroenterology, Hospital Maresca, Torre del Greco, Italy; Gastroenterology, University Federico II, Naples, Italy; Digestive Endoscopy, University Federico II, Naples, Italy; Gastroenterology, Pellegrini Hospital, Naples, Italy; Gastroenterology, Marcianise Hospital, Marcianise, Italy; Gastroenterology, Cardarelli Hospital, Naples, Italy; Statistics, University Federico II, Naples, Italy; Gastroenterology, La Schiana Hospital, Pozzuoli, Italy Background: safe and effective colonoscopy requires adequate bowel cleansing. The degree of bowel cleansing in hospitalized patients undergoing colonoscopy is often regarded as unsatisfactory compared to that of outpatients. To date, no focused study investigated the inpatient or outpatient setting as cause of inadequate cleansing. Aims: a) to assess the degree of bowel cleansing in inpatients vs. outpatients and b) identify possible predictors of poor bowel preparation in the two populations. Methods: prospective multicenter cross-sectional study including consecutive patients undergoing colonoscopy in 25 endoscopy units of Campania region in Southern Italy. Degree of bowel cleansing was rated on a segmental scoring scale of 1 to 4 by using a simplified Boston Bowel Preparation Scale. Univariate and multivariate analysis with odds ratio estimation were performed. Results: data from 3,276 colonoscopies were analyzed (2178 outpatients and 1098 inpatients). Inadequate colon cleansing (poor/fair) was recorded in 35.1% of cases at the level of proximal colon and 22.9% at left colon (p!0.01). An incomplete colonoscopy due to inadequate cleansing was recorded in 369 pts (11.2%), and in almost 50% of them it was due to poor cleansing of the proximal colon (p!0.001). There was no significant difference in bowel cleansing rates between inpatients and outpatients (23.5% and 22.6% fair/poor preparation vs. 76.5% and 77.4% good/excellent preparation, respectively. pZ0.58 and pZ0.18). The presence of comorbidity and co-prescriptions was significantly higher in inpatients than in outpatients (75.5% vs. 56.7% and 75.8% vs. 61.8%; p! 0.001). Regardless of the setting, independent predictors of poor bowel preparation were: male gender, presence of comorbidity (in particular diabetes), BMI O25, chronic constipation, absence of any explanation by medical or nursing staff, high-volume preparation, non-split dosage schedule and incomplete intake of the purge (Table). Conclusions: although the hospitalized population is at increased risk of inadequate bowel cleansing, there is no difference in the rate of inadequate preparation between inand outpatients This result could be the effect of the better explanation of the importance/modality of purge intake AB564 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014 made by physicians and/or nurses that can in some way compensate the presence of several risk factors. Obesity, comorbidity, chronic constipation, hi-volume preparation, non-split dosage schedule and incomplete intake of the purge turned out to be independent predictors of poor bowel preparation. The project was named after and carried out in loving memory of our colleague and friend Roberto Piscopo, MD. independent predictors of inadequate (fair/poor) bowel cleansing at logistic regression analysis Right colon Left colon Adjusted OR [95% CI] P value Adjusted OR [95% CI]

Age Is the Only Predictor of Poor Bowel Preparation in the Hospitalized Patient

Purpose: Poor bowel preparation leads to a need for repeated colonoscopy procedures, with resultant increased length of stays and health care costs. Few investigators have assessed these outcomes in hospitalized patients. Given these considerations, we sought to examine the prognosticating value of several key clinical variables on the likelihood of inpatient poor bowel preparation for colonoscopy. Methods: The records of consecutive patients who underwent colonoscopy at our institution between January 1, 2006 and December 31, 2011 during hospitalization were retrospectively extracted from a dedicated electronic digestive endoscopic institutional database (Endoworks, Olympus, Center Valley, PA). Six individuals independently reviewed hospital charts with 10% of all entered data audited for validation by a separate data entry associate. Univariable and multivariable analyses using logistic regression were carried out assessing clinical variables assumed to possibly be predictive of a poor colonic preparation including gender, use of narcotics, heavy medication burden, comorbidities, history of previous abdominal surgery, marital status, patient with diabetes or a neurological disorder such as stroke, hemiplegia or dementia, as well as product used for bowel preparation and whether or not the bowel regimen was given as split or standard dose as well as time of endoscopy. Data collection and analyses were undertaken following approval and institutional oversight by the Institutional Review Board for the Protection of Human Subjects. Results: Overall, 244 charts of patients undergoing colonoscopy during a hospitalization were assessed. Of those, 83 (34%) patients had poor bowel preparation. During endoscopic examination, the cecum was reached in 193 patients (79.1%). The mean age of the patients was 66 years, 133 were men (54.5%). In univariable analyses, the only clinical variable associated with a poor bowel preparation was advancing age (OR=1.03, 95% CI 1.01 to 1.05, p=0.002). In multivariable logistic regression analyses, it remained independently and significantly predictive (OR=1.026, 95% CI 1.006 to 1.045, p=0.008). Conclusion: In this retrospective cohort analysis, age was found to be the only independent significant predictor of poor bowel preparation amongst hospitalized patients. Further studies are required to help identify and correct factors causing poor bowel preparation in the admitted patient.

Tu1410 Does Obesity Have an Impact on Bowel Preparation for Screening Colonoscopy? A Prospective Study Using the Boston Bowel Preparation Score

Inadequate bowel preparation is associated with missed lesions, repeat procedures, high cost and increased risk of complications during colonoscopy. Previous studies have shown increased body mass index (BMI) as a predictor of poor bowel preparation. Most studies are retrospective and standardized bowel preparation scoring scales to determine quality of preparation in different segments of colon had not been used.

A Predictor of Poor Bowel Preparation for Colonoscopy

Data are lacking to support the observation that obese patients often have unsatisfactory bowel preparation for colonoscopy. To determine the

Predictors of Poor Bowel Preparation in Colonoscopy

Purpose: A poorly prepared colon can lead to missed lesions and repeated procedures that increase cost and complication risk. The aim of the study was to identify predictive factors of poor colon prep, including obesity, which increases risk of neoplasia. Methods: Retrospective review of 1815 reports of inpatient (IP) and outpatient (OP) colonoscopies performed from June to October 2007 at a tertiary referral center. Prior colectomy, repeat colonoscopy, incomplete reports were excluded and 1588 reports analyzed. The endoscopist's inability to adequately evaluate the entire colonic mucosa and request for earlier than expected repeat colonoscopy (ACG, ASGE guidelines) were used to determine a poor or inadequate prep (PIP). Results: Good to excellent prep quality was reported in 400 (25.2%) patients and PIP in 627 (39.5%) patients. Patients with PIP were older (59.57 ± 13.5 yrs) and had higher weight (86.19 ± 23.9 kg) and BMI (29.74 ± 7.84 kg/m2) (P < .01). In univariate analysis, male gender, inpatient status (IP), Polyethylene glycol based lavage (PEG), smoking, lack of regular alcohol consumption, diabetes mellitus (DM), hypertension, coronary artery disease (CAD) increased BMI, depression, mental retardation (MR) and use of anti-depressant medications or narcotics were predictive of PIP. However, in multivariate logistic regression analysis, only male gender (OR = 0.75, P= 0.02), IP status (OR = 1.92, P= 0.002), smoking (OR = 1.62, P= 0.003), lack of regular alcohol consumption (OR = 0.68, P= 0.0003), DM (OR = 1.64, P= 0.0006), MR (OR = 3.54, P= 0.0004), narcotic use (OR = 3.04, P < 0.0001), and PEG (OR = 0.53, P= 0.0004) were predictors of poor bowel preparation. Modeling for composite outcome using univariate analysis: older age, male gender, IP status, smoking, lack of regular alcohol consumption, DM, hypertension, CAD, increased BMI, depression, obstructive sleep apnea, MR and consumption of anti-depressant medications or narcotics were predictive of PIP. However, in multivariate logistic regression analysis, only older age (OR = 1.009, P= 0.01), male gender (OR = 0.71, P= 0.002), IP status (OR = 1.55, P= 0.008), smoking (OR = 1.35, P= 0.01), lack of regular alcohol consumption (OR = 0.7, P= 0.01), increased BMI (OR = 1.02, P= 0.004), MR (OR = 2.17, P= 0.03), use of antidepressant medication (OR = 1.69, P= 0.001), and narcotic use (OR = 2.1, P= 0.001) were predictors of PIP. Conclusion: Poorly prepped colons reduce diagnostic yield. Aborted and repeat procedures greatly increase the cost of colonoscopy. Prior identification and aggressive bowel cleansing of patients with predictive factors of PIP can lead to improved diagnostic yield and cost savings. This needs to be verified in a prospective study.

Magnesium Citrate Plus Golytely Versus Golytely Alone in Bowel Preparation for Colonoscopy

Purpose: Inadequate bowel preparation for colonoscopy can lead to failure to detect missing polyps or small cancers, prolonging the time of procedure, and increasing cost due to the need of a repeat exam. The predictors of poor bowel preparation include male gender, failure to follow instructions, and diabetes. Sharma et al has shown that magnesium citrate pretreatment two hours prior to 4L Golytely compared to Golytely alone reduced the amount of Golytely consumed and the amount of liquid stools aspirated. Sharma et. al. subsequently found that magnesium citrate plus 2L Golytely produced a better quality of bowel preparation than 4L Golytely alone. Al-Shuriek, however, found conflicting results, with Golytely preparation superior to the combination of magnesium citrate and 2L Golytely. The aim of this study is to compare Magnesium Citrate given one day prior to 4L Golytely versus 4L Golytely alone in bowel preparation quality for colonoscopy. Methods: 52 patients scheduled for outpatient colonoscopy were randomized into Groups 1 (n = 28) and 2 (n = 24). Patients in Group 1 received magnesium citrate 300ml at 6:00pm two days prior to colonoscopy, and began a clear liquid diet. They received 4L Golytely at 1:00pm the day prior to colonoscopy. Patients in Group 2 followed the same regimen without magnesium citrate pretreatment. The quality of bowel preparation was evaluated by two experienced endoscopists using a Global Preparartion Assessment scale (1–4, 1 = excellent, 4 = poor) and Stool Score (0–11) that were validated in prior studies. The results in the two groups were compared. Statistical significance is defined by P value < 0.05. Results: The baseline characteristics between the two groups were similar as to age, gender, presence of diabetes, and narcotic use. The mean Global Assessment Scale for Group 1 was 2.07, and for Group 2 was 1.79 (p > 0.05). The mean Stool Score for Group 1 was 3.27, and for Group 2 was 2.77 (p > 0.05). When combining the two groups together, mean Stool Score for left colon was 2.38, and for right colon was 3.69 (p < 0.05). Conclusions: Magnesium Citrate given one day prior to Golytely did not improve bowel preparation quality compared to Golytely alone. An incidental finding was that the quality of bowel preparation was significantly better in left colon than right colon in both groups.

Oral sodium phosphate compared with water enemas combined with Bisacodyl as bowel preparation for elective colonoscopy

Background: Colonoscopy with high diagnostic accuracy requires a high quality of bowel preparation using a method that is well accepted. The aim of this study was to compare oral intake of sodium phosphate solution (SP) with a conventional method of bowel preparation using Bisacodyl combined with repeated water enemas until the appearance of clear return fluid (BE) on bowel preparation and to compare patient compliance in a randomized‐investigator blinded trial. Methods: During a 3‐months period, 253 consecutive patients referred for elective colonoscopy in the outpatient clinic were evaluated. After application of the exclusion criteria, 201 patients fulfilled the criteria for the trial; 119 were randomized to SP and 82 to BE. Results: The endoscopist reported a significantly (P = 0.001) improved overall bowel preparation after SP compared with BE. Emptying was significantly better in all segments of the colon except the caecum. Colonoscopy was incomplete in 9 patients (7.6%) in the SP group and in 3 patients (3.7%) in the BE group, but this difference was not significant. The number of patients with colon pathology was similar in both groups. Only 10% in the SP group would have preferred another preparation had this been possible, compared with 89% in the BE group (P < 0.0001). Only the SP preparation emerged as a negative independent predictor of poor bowel preparation after multivariate logistic regression modelling. Conclusion: Patient compliance and quality of bowel preparation were better after SP than after BE.