Predictors Of Inadequate Bowel Preparation Research Articles

Effect of acuity level and patient characteristics on bowel preparation quality: a retrospective cohort study of inpatient colonoscopies

Background and aimsColonoscopy is the primary method to detect mucosal abnormalities in the colon, rectum, and terminal ileum. Inadequate bowel preparation is a common problem and can impede successful visualization during colonoscopy. Although studies identified hospitalization as a predictor of inadequate bowel preparation, acuity of care vary greatly within this patient population. The current study aims to examine the effect of patient characteristics and care level predictors on inadequate bowel preparation quality within the inpatient setting.MethodsThis retrospective study was conducted in a single urban level 1 trauma medical center and included adult patients undergoing diagnostic colonoscopy while admitted in the hospital from January 1, 2015 to June 30, 2020. We examined the level of inpatient care between the General Medical Floor (GMF), Intensive Care Units (ICU) and Telemetry Unit (TU) and assessed this association with bowel preparation quality, adjusting for known and unknown predictors.ResultsOf 538 patients undergoing colonoscopy, 47.4% were admitted into TU, 43.7% into GMF and 8.9% into ICU. For the entire sample, 72.7% of patients achieved good or excellent preparation and quality of bowel preparation differed by care level (P = 0.01). Patients from the critical care units were less likely to achieve adequate bowel preparation when compared to GMF (Odds Ratio [OR] 0.36; 95% Confidence Interval [CI] 0.17,0.77), after adjusting for patient characteristics, medications, physical status, and preparation regimen. No significant difference in Bowel Preparation Quality (BPQ) was identified between patients from GMF and TU (OR 0.96; 95%CI 0.61, 1.52). Furthermore, adequate BPQ was associated with withdrawal time and cecal intubation, but not higher adenoma detection rates.ConclusionsResults suggest the ICU setting is an independent predictor for inadequate bowel preparation and patients with prior opioid and laxative use may be more likely to have inadequate bowel preparation in the hospital. Future interventions should prioritize preprocedural clinician meetings for critical care unit patients, including a more detailed readiness assessment and thorough medication history.

Bowel cleansing efficacy of 1L NER1006versus macrogol and 3L polyethylene glycol using split-dose administration.

Colonoscopies are an important diagnostic technique in the detection of colorectal cancer and colonic disease. Adequate examination is dependent on the degree of mucosal visibility, with poor cleansing impeding the detection of neoplasms. These patients require shorter colonoscopy surveillance intervals, longer hospital stays, and increased healthcare costs-rendering a screening colonoscopy cost-ineffective. In Australia and the Gold Coast Hospital and Health Service (GCHHS), macrogol and 3L of polyethylene glycol are the preferred regimen given its safety profile and efficacy. Yet, little is known locally about the use of the new low-volume bowel preparation NER1006 (Plenvu) given its recent registration with the Therapeutic Goods of Australia (TGA). The primary outcome assessed the bowel cleansing efficacy of NER1006 compared with 7 days of macrogol and 3L of polyethylene glycol using the Boston Bowel Preparation Scale (BBPS), while also assessing the influence of notable patient characteristics such as age, gender, body mass index (BMI), and the patients Charlson comorbidity index (CCI). Secondary outcomes assessed the polyp detection rate and procedural factors including cecal intubation, scope withdrawal time, and rebooking rates. Data from all patients who underwent an outpatient colonoscopy procedure at GCHHS between 1 July 2020 and 30 September 2020 were analyzed. Patients were aged 50-74 years of age and were referred for a screening colonoscopy due to a positive fecal occult blood test (FOBT) result from the National Bowel Cancer Screening Program. Of the 238 patients who met the inclusion criteria, 108 patients received NER1006 and 130 patients received macrogol and 3L polyethylene glycol. NER1006 achieved superior overall (P< 0.001) and right-sided colon cleansing (P= 0.016). There was an even distribution of males and females (P= 0.118), the mean age of both cohorts was <65 years of age. The macrogol and 3L polyethylene glycol group had a statistically higher BMI (P< 0.001) and CCI (P< 0.001). Cecal intubation success was achieved in both cohorts (≥95%) and scope withdrawal time was ≥6min, polyp detection was non-superior (P= 0.824), but superior in NER1006 when BBPS ≥6 (P= 0.002). Rebooking rates were significantly lower in the NER1006 group (P= 0.013). This study demonstrated that NER1006 was superior in terms of overall and right-sided bowel cleansing as a primary endpoint. Patient factors demonstrated to be independent predictors of inadequate bowel preparation. Future studies should aim to explore the safety and tolerability of NER1006 while also assessing the bowel cleansing effectiveness in patients with a high BMI and comorbidity index.

P158 Disease and non-disease-related risk factors for inadequate bowel preparation in patients with inflammatory bowel disease: should the strategy be different?

Abstract Background Colonoscopy is of utmost importance in the management of inflammatory bowel disease (IBD) and is a critical tool for diagnostic and therapeutic decision-making. The quality of bowel preparation is important for the efficacy of colonoscopy and inadequate bowel preparation (IBP) is associated with increased costs and inconvenience. Most studies on IBP have not specifically evaluated the impact of concomitant conditions, such as IBD, on the quality of bowel preparation. We aimed to identify disease and non-disease related factors for IBP in patients with IBD submitted to colonoscopy. Methods Retrospective cohort-study which included adult IBD patients submitted to colonoscopy between 2016–2021. Patients’ demographic, comorbidities, clinical, biochemical, and colonoscopy data were recorded. IBP was defined as a final Boston Bowel Preparation Scale (BBPS) ≤5 or ≤1 in at least one segment. A univariable analysis tested the association between covariables and the outcome (IBP) in general and considering Crohn’s disease (CD) and ulcerative colitis (UC) patients separately. Statistically significant variables were included in multivariable logistic binary regression. Results Of 309 patients, 52.4% were female with a mean age of 43.7±13.7 years. Fifty one percent (n=158) had UC and 48.9% (n=151) had CD. Twenty-seven percent of the patients (n=82) had IBP which was not significantly different between UC and CD patients (40vs42, p=0.699, respectively). The presence of diabetes mellitus (adjusted OR 13.9 [95% CI 1.388–139.624], p&amp;lt;0.05) and antidepressant use (adjusted OR 4.1 [95% CI 1.247–13.625], p&amp;lt;0.05) were independently associated with the outcome in general. In contrast, only previous history of IBP (adjusted OR 3.1 [95% CI 1.184–8.271], p&amp;lt;0.05) was independently associated with the outcome in UC patients. Disease-related factors such as previous surgery, steroids, immunosuppressors or biologics and endoscopic activity were not associated with IBP. Conclusion This study demonstrates that the presence of diabetes mellitus and antidepressant use are predictors of inadequate bowel preparation for colonoscopy in patients with inflammatory bowel disease. Disease-related factors seem to have no influence in the quality of bowel preparation suggesting that a specific approach is unnecessary in these patients.

A108 ARE INPATIENTS STILL MORE LIKELY TO FAIL BOWEL PREPARATION IN THE SPLIT-DOSE ERA? FINDINGS FROM 47, 292 COLONOSCOPIES IN THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

Abstract Background Prior studies before the widespread use of split-dose bowel preparation have shown a high rate of inadequate bowel preparation in hospitalized patients. Whether this is still true in the era of split-dose bowel preparation is unknown. Aims To determine the impact of inpatient status on bowel preparation quality in the contemporary era of split-dose bowel preparation. Methods The Southwest Ontario Colonoscopy cohort consists of all inpatient and outpatient colonoscopies performed between April 2017 and Oct 2018 at 21 hospitals serving a large geographic health region. Procedures done in patients &amp;lt; 18 years of age or by an endoscopist performing &amp;lt;50 colonoscopies/year were excluded. Data were collected through a mandatory quality assurance form that was completed by the endoscopist after each procedure. Pathology reports were manually reviewed. The primary outcome was adequate bowel preparation, defined on an ordinal scale as “good” or “fair” rather than “poor”. Secondary outcomes included adenoma detection rate (ADR), sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), and cecal intubation rate (CIR). Results A total of 47,292 colonoscopies were performed by 75 physicians (36.2% by gastroenterologists, 60% by general surgeons, 4% others), of which 1,690 were inpatients (3.6%). Inpatients were older (mean 66.8 years vs 60.2 years, p&amp;lt;0.0001), more co-morbid (≥ASA grade 3, 53.6% vs 23.7%, p&amp;lt;0.0001), performed for symptomatic indications (95.7% vs 48.6%, p&amp;lt; 0.0001), have trainee involvement (47% vs 11.6% p&amp;lt;0.001), and less likely to receive split-dose bowel preparation (71.7% vs 91.6% p&amp;lt;0.001). On crude analysis, inpatients were less likely to have adequate bowel preparation (86.2% vs 97.6% p&amp;lt;0.001). On multi-variable analysis, inpatients had lower odds of achieving adequate bowel preparation (OR=0.41, 95% CI 0.33 - 0.50, p&amp;lt;0.001), lower ADR (OR=0.47, 95% CI 0.40 - 0.55, p&amp;lt;0.001), lower PDR (OR=0.54, 95% CI 0.47 - 0.61 p&amp;lt;0.001) and lower CIR (OR = 0.43, 95% CI 0.35 - 0.54, p&amp;lt;0.001). Conclusions In the era of split-dose bowel preparation, inpatient status is still an important predictor of inadequate bowel preparation with resultant lower quality outcome metrics. Funding Agencies None

Predictors of inadequate bowel preparation using two liters of polyethylene glycol for colonoscopy

Background: Inadequate bowel preparation can result in missed pathological lesions and cancellation of procedures thereby increasing the cost and delay in the diagnosis.&#x0D; Objectives: Thes aim of the study was to identify the potential predictors of inadequate bowel preparation using 2 liters of polyethylene glycol solution.&#x0D; Methodology: A prospective study was done, which included 138 consecutive patients who underwent colonoscopy over a period of 6 months. Patient’s demographics, medical history, and preparation quality were collected and compared. Factors associated with inadequate bowel preparation were identified by univariate statistics and multivariate logistical regression analysis.&#x0D; Results: Out of 138 colonoscopy procedure, 119 (86.2%) preparations were adequate and 19 (13.8%) were inadequate. The mean age of the patient was 52.62 (SD ±10.51) years. Out of which, 82 (59.4%) were male and 56 (40.6%) were female. In the multivariate regression analysis, constipation [adjusted OR 8.55, 95% CI 1.79-41.67] and non-compliance [adjusted OR 58.82, 95% CI 5.99-500] were independently associated with inadequate bowel preparation.&#x0D; Conclusion: Constipation, non-compliance, overweight, neurological disorders like stroke, dementia and age &gt;60 years were associated with inadequate bowel preparation. Early identification of patients with a high risk of inadequate preparation can be salvaged with change in bowel cleaning strategy.

Mo1747 ONE WEEK POLYETHYLENE GYCOL (PEG) 3350 FOLLOWED BY SPLIT DOSE PEG ELECTOLYTE SOLUTION WITH OR WITHOUT ASCORBIC ACID IMPROVED COLONOSCOPY BOWEL PREPARATION IN PATIENTS WITH CONSTIPATION: A QUALITY IMPROVEMENT PROJECT AT A LARGE VETERANS AFFAIRS HOSPITAL

High quality bowel preparation is crucial for an effective examination of the colon during colonoscopy. Diabetes, chronic constipation, spinal cord injury, and the use of medications such as narcotics and tricyclic antidepressants are well known predictors of inadequate bowel preparation. The 2014 US Multi-Society Task Force guidelines do not recommend the use of a specific bowel regimen in high risk patients, and limits its statement to the favorable use of additional purgatives in this group of patients (weak recommendation, low quality evidence). We aimed to identify the rate of inadequate bowel preparation in high risk patients and to compare the efficacy of different types of bowel preparations in this population. We identified colonoscopies (n=3651) performed at our institution between January 2019 until November 2019. Patients at high risk for inadequate preparation were identified by specific ICD-10 codes for constipation, diabetes or spinal cord injury or by review of outpatient pharmacy orders for narcotics, antidepressants or laxatives. Bowel preparation adequacy was reported according to the 4- point Boston Bowel Preparation Scale. Mid-P Exact test was used to compare the rates of poor bowel preparation in constipated patients according to the bowel preparation received. The majority of patients were male (92.3%) with a mean age of 64.2+10.4. Approximately 65% of patients received a split dose PEG electrolyte solution with ascorbic acid (Moviprep), 25% received 1 week of PEG 3350 (Miralax) prior to a split dose Moviprep or PEG electrolyte solution (Golytely), and 9.5% prepped with Golytely. Overall, 680 colonoscopies (18.6%) had inadequate bowel preparation of which 235 (6.4%) were deemed poor. A total of 2166 colonoscopies (59.3%) were performed on high risk patients (table). Among high risk patients, the rate of inadequate bowel preparation was 24.5% (figure). In a subgroup analysis on patients with constipation who were prescribed laxatives (n=984), the rate of poor bowel preparation was significantly reduced in patients who received 1 week of Miralax followed by split dose Moviprep or Golytely (13.9%) compared to Split dose Moviprep or Golytely alone (19.9%) OR= 0.65( 95% CI: 0.46-0.91, p=0.006). High risk patients have an increased rate of inadequate bowel preparation. One week of Miralax followed by split dose Moviprep or Golytely reduced the rate of poor bowel preparation in constipated patients on laxatives. If proven beneficial in large randomized controlled trials, this method of preparation will reduce repeated colonoscopies and wasted capacity in endoscopy unit.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Factors influencing inpatient colonoscopy bowel preparation quality.

Colonoscopy is highly sensitive for the visualization of the entire colon. Inpatient colonoscopies pose a special risk of poor preparation. We reviewed bowel preparation methods and patient factors to identify predictors of inadequate bowel preparation for inpatient colonoscopy at our institution. The purpose of this study was to identify factors that predict inadequate bowel preparation for inpatient colonoscopies. All patients ages >18 years of age undergoing inpatient colonoscopy in 2017-2018 were reviewed. The primary outcome was inadequate bowel preparation and secondary outcomes were successful cecal intubation, duration of colonoscopy, and hospital length of stay (LOS). Outcomes were compared using multivariable regression with stepwise covariate selection. The analysis included 315 patients (median age =67 years; 45% female). Visualization was deemed adequate in 56%, fair in 27%, and poor in 17% of cases. Cecal intubation was successful in 84% of cases. The median duration of colonoscopy was 25 min and LOS was 2 days. Unsuccessful cecal intubation was most likely with poor visualization compared to adequate visualization (36% vs. 11%, P=0.014). There was no increased colonoscopy duration with poor visualization (P=0.075). There was no significant LOS with worse visualization quality (P=0.185). Factors predicting worse visualization quality included older age, history of congestive heart failure (CHF), cirrhosis, and motility disorders. At our institution, patients who were older or had significant comorbid conditions (chronic artery disease, CHF, chronic obstructive pulmonary disease, motility disorders, or cirrhosis) were more likely to have inadequate inpatient bowel preparation. Bowel preparation type did not affect the duration, quality of visualization, or successful cecal intubation.

Sodium phosphate is superior to polyethylene glycol in constipated patients undergoing colonoscopy: a systematic review and meta-analysis.

Constipation is an important and highly prevalent predictor of inadequate bowel preparation during colonoscopy. In North America, between 2 and 28% of the general population suffer from constipation. Despite the high prevalence of constipation, to our knowledge, no meta-analysis on the optimal bowel preparation for constipated patients has been performed. We aimed to systematically review the literature to determine the ideal bowel preparation regiment for patients with chronic constipation. A comprehensive search of electronic databases (MEDLINE, EMBASE, SCOPUS, and Web of Science) was performed. We included studies that assessed the quality of bowel preparation in constipated patients receiving different agents prior to colonoscopy. The primary outcome was colon cleanliness. Secondary outcomes included tolerability of the bowel preparation and serious adverse events. Preliminary database search yielded 1581 articles after duplicates were removed. After screening of the titles and abstracts using the exclusion criteria, 358 full-text articles were retained. Full-text articles were reviewed and eight studies meeting the inclusion criteria were included for qualitative synthesis. Three randomized controlled trials identified a total of 1636 constipated patients, of whom 225 were eligible for meta-analysis. Of those, 107 (47.6%) received NaP and 118 (52.4%) received PEG. Patients receiving NaP before colonoscopy had a higher chance of a successful bowel preparation than patients receiving PEG (OR 1.87, CI 1.06 to 3.32, P = 0.003). In the studies comparing PEG to NaP, two found that NaP resulted in greater tolerability of the bowel preparation and one study found that PEG resulted in superior tolerability. In chronically constipated patients undergoing colonoscopy, the use of NaP may result in superior colonic cleanliness when compared to PEG, however, quality of evidence was low. Further high-quality studies are required to delineate the optimal bowel preparation in patients with constipation.

156 Predictive Factors for Inadequate Inpatient Bowel Preparation

INTRODUCTION: Colonoscopy is highly sensitive for the detection of precancerous polyps and for the visualization of the entire colon during colorectal screening. Inpatient colonoscopies pose a special risk of poor preparation. We reviewed bowel preparation methods and patient factors to identify predictors of inadequate bowel preparation for inpatient colonoscopy at our institution. METHODS: All patients ages older than 18 years of age undergoing inpatient colonoscopy in 2017–2018 were reviewed. The primary outcome was inadequate bowel preparation and secondary outcomes were successful cecal intubation, duration of colonoscopy, and hospital LOS. Outcomes were compared according to demographic characteristics, comorbidities, abdominal surgery, and medications using multivariable regression with stepwise covariate selection. Statistical significance was set at P &lt; 0.05. RESULTS: The analysis included 315 patients (median age = 67 years; 45% female, Table 1). The majority of colonoscopies were performed for anemia (78%). Visualization was deemed adequate in 56%, fair in 27%, and poor in 17% of cases. Cecal intubation was successful in 84% of cases. The median duration of colonoscopy was 25 min and LOS was 2 days. Unsuccessful cecal intubation was most likely with poor visualization (36% vs 11%, P = 0.014). There was no increased colonoscopy duration with poor visualization (P = 0.075). There was no significant LOS with worse visualization quality (P = 0.185). Factors predicting worse visualization quality included older age, history of CHF, cirrhosis, and motility disorders (Table 2). Older age, COPD, and colonoscopy performed for other indications were associated with unsuccessful cecal intubation. Factors predicting prolonged LOS included several comorbidities and usage of iron or neuromodulators (Table 3). CONCLUSION: At our institution, patients who were older or had significant co-morbid conditions (CAD, CHF, COPD, motility disorders, or cirrhosis) were more likely to have inadequate inpatient bowel preparation. Other studies found similar findings in patients with diabetes, cirrhosis, history of stroke or TCA use. Bowel preparation type did not affect the duration, quality of visualization, or the success of cecal intubation. Further work is needed to optimize inpatient bowel preparation protocols in older patients with multiple co-morbidities. Future studies should evaluate the success of bowel preparation in inpatient setting with a standardized bowel preparation score like the Boston Bowel Prep score.

Usefulness of Personal Bowel Habits as a Predictive Factor for Inadequate Bowel Preparation for Colonoscopy: A Prospective Questionnaire-Based Observational Study.

Background/AimsThe quality of bowel preparation is important for optimal colonoscopy. It is influenced by medical and personal factors. We aimed to evaluate the effect of bowel habit on the quality of bowel preparation and to identify predictors of inadequate bowel preparation among bowel habit factors.MethodsFrom June 2017 to September 2017, 90 volunteers were enrolled in this study. Each participant answered a questionnaire consisting of multiple questions about personal bowel habits, including stool form, frequency of bowel movements per week, duration, and degree of straining for bowel movement. Then, all volunteers underwent colonoscopic exam. Eleven endoscopists performed colonoscopies and used the Boston Bowel Preparation Scale (BBPS) as the index for bowel preparation. Two expert endoscopists simultaneously reviewed all colonoscopic images to confirm the final BBPS. Univariate and multivariate logistic regression analyses were performed to verify the correlation between bowel preparation adequacy and bowel habit.ResultsAmong the 90 participants, 20 (22.2%) had inadequate bowel preparation (total BBPS ≤6 or any segmental BBPS ≤1). In univariate analysis, infrequent bowel movement (0–2/week) (odds ratio [OR], 12.60; 95% confidence interval [CI], 1.22 to 129, p=0.03) and moderate straining (more than 1/4 of defecations) (OR, 4.40; 95% CI, 1.44 to 13.39; p=0.01) were significantly associated with inadequate bowel preparation. However, only moderate straining was significantly associated with inadequate bowel preparation in multivariate analysis (OR, 3.99; 95% CI, 1.26 to 12.65; p=0.02).ConclusionsStraining is a significant predictor for inadequate bowel preparation. For patients with straining during bowel movements, an intensified preparation regimen should be considered.

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

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.

Analysis of Adequacy of Bowel Preparation in Patients Receiving Onsite Dosing

Introduction: Split dose bowel preparation has been shown to be superior to same day or previous day preparation and has been associated with higher adenoma detection rates and improved patient tolerance. The aim of the study was to evaluate bowel prep quality and factors impacting it in patients undergoing onsite split dosing. Methods: Data was retrospectively collected from an endoscopy database of a single large tertiary referral center of adult patients who underwent colonoscopy from January 2005 to November 2015. Patient demographics (age, race, gender, BMI, use of medications), data about presence of comorbidities and colonoscope type (standard definition, high-definition) were collected. Bowel preparation was defined as adequate if it was scored as good or excellent and inadequate if it was poor or fair. Redo colonoscopy was defined as a repeat colonoscopy within 6-12 months from preceding colonoscopy due to inadequate mucosal visualization. For univariate analysis, continuous variables were compared using Student's T-test and categorical variables were compared using chi-square or Fisher's exact test. Multivariate analysis was done using logistic regression model. Results: A total of 2138 patients who underwent 2893 colonoscopies were included in the study. The mean age of the patients was 66.3 years and 95.6% of them were males. Bowel preparation was inadequate in 214 (7.4%) patients. The demographics of the patients in both groups (adequate vs. inadequate prep) are listed in Table 1. Patients with an inadequate bowel preparation had significant lower adenoma detection rates (49.5% vs 63.4%, p<0.001); total number of adenomas removed (1.5 ± 2.7 vs. 1.9 ± 2.4; p<0.001) and cecal intubation rates (93.5% vs. 98.1%; p< 0.001). On multivariate analysis after adjusting for age, gender, and race, the presence of cirrhosis is associated with a higher risk of inadequate bowel preparation (OR 2.75, 95% CI 1.1-6.87, p=0.031). The odds of having a redo colonoscopy with inadequate prep was nearly twice as that with adequate preparation (OR 1.95, OR 1.15-3.31, p=0.014). Conclusion: Use of an onsite split dose bowel prep is associated with only 7% overall inadequate bowel preps, with 93% of the preps being either good or excellent. Inadequate bowel preps are associated with lower ADRs, adenomas removed and cecal intubation rates and higher colonoscopy re do rates. Cirrhosis appears to be a risk factor for inadequate bowel prep.2764_A Figure 1. Demographic variables, redo rates and quality indicators2764_B Figure 2. Multivariate logistic regression for predictors of inadequate bowel preparation

Predictors of inadequate bowel preparation for colonoscopy: a systematic review and meta-analysis.

The aim of this study was to investigate factors contributing to poor bowel preparation in patients undergoing colonoscopy procedures. We used a reproducible search strategy to identify studies, searching 10 medical databases, including PubMed, Ovid, Medline, and Cochrane Library Database for reports published between 2000 and 2016. Fully published studies, evaluating risk factors for inadequate bowel preparation, were included. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. Pooling was conducted with both fixed-effects and random-effects models; results were presented from the random effects model when heterogeneity was significant. Odds ratios (OR) estimates with 95% confidence interval were calculated. Heterogeneity was assessed by I statistics. Twenty-four studies with a total of 49 868 patients met the inclusion criteria. Age (OR: -1.20), male sex (OR: 0.85), inpatient status (OR: 0.57), diabetes mellitus (OR: 0.58), hypertension (OR: 0.58), cirrhosis (OR: 0.49), narcotic use (OR: 0.59), constipation (OR: 0.61), stroke (OR; 0.51), and tricyclic antidepressant (TCA) use (0.51), were associated with inadequate bowel preparation. In our sensitivity analysis comparing Western and Asian countries, we found that diabetes, cirrhosis, male sex, history of stroke and TCA use were stronger risk factors for inadequate bowel preparation in Western countries than in Asian countries. We also found that history of stroke, TCA use, and race were risk factors for inadequate bowel preparation in patients receiving conventional bowel preparation compared with those receiving split-dose bowel preparation. Multiple risk factors affect the quality of bowel preparation and specific risk factors can be intervened upon, in different populations, to optimize preparation.

Predictors of Inadequate Bowel Preparation at Colonoscopy

To identify risks for inadequate bowel preparation at colonoscopy, researchers conducted a systematic review and meta-analysis comprising 67 studies

Su1577 - Predictors of Inadequate Bowel Preparation in 91,045 Ambulatory Patients in Open Access Endoscopy Practice

Su1577 - Predictors of Inadequate Bowel Preparation in 91,045 Ambulatory Patients in Open Access Endoscopy Practice

Mo1604 - Predictors of Inadequate Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis

Mo1604 - Predictors of Inadequate Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis

Predictors of Inadequate Bowel Preparation and Salvage Options on Colonoscopy

Inadequate bowel preparation is observed in more than 25% of all colonoscopies. Identification of predictive factors for inadequate colon cleaning is helpful and more detailed preparation methods should be used for patients at high risk. Age, male sex, inpatient status, and comorbidities were identified as independent risk factors in several previous studies. In patients with insufficient colon preparation, colon irrigation with endoscopic pumps or next-day colonoscopy following further bowel cleaning should be performed. In order to improve the efficacy and safety of both bowel preparation and colonoscopy, the endoscopic team should identify the patient’s medical conditions and choose the optimal bowel preparation agent and regimen.

A Systematic Review of Hydrogen Breath Testing as a Predictor of Bowel Preparation Quality

Introduction: Inadequate bowel preparation causes significant clinical and economic harms. This systematic review aims to assess the accuracy of hydrogen breath testing as a predictor of inadequate bowel preparation. Methods: Studies were identified from MEDLINE, Embase, Web of Science, Cochrane Library, and clinicaltrials. gov. Two investigators evaluated each abstract for the following inclusion criteria: report of correlation between hydrogen breath levels and bowel preparation quality by any scale, prospective design, and non-emergent colonoscopy in adults. Included studies underwent duplicate data extraction using a standardized approach. The quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results: 159 publications were identified, and 6 unique studies met inclusion criteria, including 4 from full text articles and 2 from abstracts. The number of patients analyzed ranged from 61 to 127. Four studies were performed in the US, 1 in Japan and 1 in Italy. Three studies used a prebiotic in addition to a purgative, with the intention of enhancing the discriminating ability of hydrogen breath levels. Only 3 studies assessed baseline hydrogen levels. In 5 of the 6 studies, hydrogen breath levels were predictive of inadequate bowel preparation. Suggested absolute hydrogen level cutoffs to distinguish adequate from inadequate bowel preparation ranged from 3 to 10 parts per million. Depending on the cutoff value, sensitivity ranged from 71-100% and specificity ranged from 87-100%. There was significant heterogeneity among studies in breath testing protocol and breath analyzer used. Studies provided limited information on the proportion of patients who had altered GI anatomy or were non-hydrogen producers. The full text studies had low risk of bias in most assessed domains. The quality of the abstracts could not be assessed due to limited data. Conclusion: Hydrogen breath levels can be used to predict bowel preparation adequacy, potentially with high reliability, but existing studies have significant limitations. Further studies should use standardized methods and consider the real-world practicality of self-administered home breath testing.

Bowel Preparation Adequacy in Patients With Developmental Disabilities

Introduction: With the rising number of individuals with developmental conditions entering adulthood, it is anticipated that there will be a concomitant rise in the number of endoscopic procedures that will be performed by gastroenterologists for this population. Adults with intellectual and developmental disabilities may be considered a high-risk group for colonoscopies due to the presence of co-morbidities affecting preparation and compliance, and thus can impact the quality and safety of the procedure. Existing literature is unclear regarding the rate of optimal bowel preparation in this patient population. Methods: A chart review of patients with developmental disabilities who underwent lower endoscopy in three hospital-based endoscopy centers from 2006-2013 was conducted. Search terms to capture the patient population of interest in our database included Asperger Syndrome, Autistic Disorder, Developmental Delay, Down Syndrome, Mental Retardation, Intellectual Disability, and Other Pervasive Developmental Disorder. These ICD codes were then cross-referenced with the corresponding codes for colonoscopies and sigmoidoscopies. The extracted charts were then reviewed to determine preparation quality and procedure completion rates. Results: From 2006-2013, a total of 216 patients with developmental disabilities underwent lower endoscopy in the three endoscopy centers. Of these, a total of 129 patients had preparation quality available for review, and were included in the final analysis. Mean age at the time of endoscopy was 51.6 ± 14.1 years. A total of 67 patients (51.9%) had good or adequate bowel preparation, while 30 patients (23.2%) had suboptimal preparation and 32 patients (24.8%) had poor preparation. Of the 62 patients with inadequate bowel preparation, 9 procedures (14.5%, 7.0% overall) could not be completed as a direct result. Conclusion: Inadequate bowel preparation in patients with developmental disabilities in our study was noted to be as high as 48%, which is almost double compared to existing literature regarding inadequate bowel preparation rates in the general population, which range from 20-25%. Our findings suggest that this specific patient population may be a predictor of inadequate bowel preparation, and would benefit from future studies aimed at improving the quality of colonoscopy for these patients.

Predictors of Inadequate Inpatient Colonoscopy Preparation and Its Association with Hospital Length of Stay and Costs.

Adequate bowel preparation is essential to safe and effective inpatient colonoscopy. Predictors of poor inpatient colonoscopy preparation and the economic impacts of inadequate inpatient preparations are not defined. The aims of this study were to (1) determine risk factors for inadequate inpatient bowel preparations, and (2) examine the association between inadequate inpatient bowel preparation and hospital length of stay (LOS) and costs. We performed a retrospective cohort study of adult patients undergoing inpatient colonoscopy preparation over 12 months (1/1/2013-12/31/2013). Of 524 identified patients, 22.3% had an inadequate preparation. A multiple logistic regression model identified the following potential predictors of inadequate bowel preparation: lower income (OR 1.11; 95% CI 1.04, 1.22), opiate or tricyclic antidepressant (TCA) use (OR 1.55; 0.98, 2.46), and afternoon colonoscopy (OR 1.66; 1.07, 2.59); as well as American Society of Anesthesiologists (ASA) class ≥3 (OR 1.15; 1.05, 1.25) and symptoms of nausea/vomiting (OR 1.14; 1.04, 1.25) when a fair preparation was considered inadequate. Inadequate bowel preparation was associated with significantly increased hospital LOS (model relative mean estimate 1.25; 95% CI 1.03, 1.51) and hospital costs (estimate 1.31; 1.03, 1.67) when compared to adequate preparations. The rate of inadequate inpatient bowel preparations is high and associated with a significant increase in hospital LOS and costs. We identified five potential predictors of inadequate inpatient preparation: lower socioeconomic class, opiate/TCA use, afternoon colonoscopies, ASA class ≥3, and pre-preparation nausea/vomiting; these data should guide future initiatives to improve the quality of inpatient bowel preparations.