A Predictive Factors of Inadequate Bowel Preparation for Elective Colonoscopy
Gastroenterology and Hepatology from Bed to Bench,
Background: Inadequate bowel preparation can lead to lower polyp detection rates, longer procedure times, and lower cecal intubation rates. This study was aimed to evaluate the effects of factors like demographic items, comorbidities, and drug history on the inadequacy of colonic preparation before colonoscopy.
Methods: This population-based study was conducted on 2476 Iranian adults who were referred to two tertiary centers for elective colonoscopy between 2017 and 2018. Bowel preparation quality was scored by the Boston bowel preparation scale (BBPS). Univariate and multivariate logistic regressions were used to find the independent predictors of bowel preparation inadequacy.
Results: Our results showed that 31.8% of our patients had inadequate bowel preparation before performing colonoscopy. Higher age, BMI>25, abdominal circumference>95 cm, low fruit consumption, and history of smoking were independently correlated with bowel preparation inadequacy, additionally, using NSAIDs and SSRIs were correlated with bowel preparation adequacy in multivariate regression analysis. Finally, age, gender, ethnicity, BMI, abdominal circumference, fruit consumption, smoking, NSAIDs, SSRIs, education, constipation, physical activity, and diabetes entered our predictive model. The area under the curve (AUC) reached 0.70 in the final step.
Conclusions: We found the independent risk factors associated with colonic preparation inadequacy, and finally suggested a predictive model for identifying the patients with a high risk of bowel preparation inadequacy before performing a colonoscopy to employ alternative preparation techniques among high-risk groups, to yield optimal preparation quality.
- Colonoscopy; Colon cleaning; Bowel preparation; Risk factors of bowel cleansing; quality of colonoscopy
How to Cite
1. Bénard F, Barkun AN, Martel M, von Renteln D. Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations. World journal of gastroenterology. 2018;24(1):124-38.
2. Jover R, Herraiz M, Alarcon O, Brullet E, Bujanda L, Bustamante M, et al. Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy. 2012;44(4):444-51.
3. Johnson DA, Barkun AN, Cohen LB, Dominitz JA, Kaltenbach T, Martel M, et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology. 2014;147(4):903-24.
4. Mamula P, Adler DG, Conway JD, Diehl DL, Farraye FA, Kantsevoy SV, et al. Colonoscopy preparation. Gastrointest Endosc. 2009;69(7):1201-9.
5. Connor A, Tolan D, Hughes S, Carr N, Tomson C. Consensus guidelines for the safe prescription and administration of oral bowel-cleansing agents. Gut. 2012;61(11):1525-32.
6. Adler A, Wegscheider K, Lieberman D, Aminalai A, Aschenbeck J, Drossel R, et al. Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12,134 examinations (Berlin colonoscopy project 3, BECOP-3). Gut. 2013;62(2):236-41.
7. Sulz MC, Kroger A, Prakash M, Manser CN, Heinrich H, Misselwitz B. Meta-Analysis of the Effect of Bowel Preparation on Adenoma Detection: Early Adenomas Affected Stronger than Advanced Adenomas. PLoS One. 2016;11(6):e0154149.
8. Saltzman JR, Cash BD, Pasha SF, Early DS, Muthusamy VR, Khashab MA, et al. Bowel preparation before colonoscopy. Gastrointest Endosc. 2015;81(4):781-94.
9. Rex DK, Imperiale TF, Latinovich DR, Bratcher LL. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol. 2002;97(7):1696-700.
10. Jaruvongvanich V, Sempokuya T, Laoveeravat P, Ungprasert P. Risk factors associated with longer cecal intubation time: a systematic review and meta-analysis. Int J Colorectal Dis. 2018;33(4):359-65.
11. Lebwohl B, Kastrinos F, Glick M, Rosenbaum AJ, Wang T, Neugut AI. The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy. Gastrointest Endosc. 2011;73(6):1207-14.
12. Lebwohl B, Wang TC, Neugut AI. Socioeconomic and other predictors of colonoscopy preparation quality. Dig Dis Sci. 2010;55(7):2014-20.
13. Hassan C, Fuccio L, Bruno M, Pagano N, Spada C, Carrara S, et al. A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy. Clin Gastroenterol Hepatol. 2012;10(5):501-6.
14. Chung YW, Han DS, Park KH, Kim KO, Park CH, Hahn T, et al. Patient factors predictive of inadequate bowel preparation using polyethylene glycol: a prospective study in Korea. J Clin Gastroenterol. 2009;43(5):448-52.
15. Fayad NF, Kahi CJ, Abd El-Jawad KH, Shin AS, Shah S, Lane KA, et al. Association between body mass index and quality of split bowel preparation. Clin Gastroenterol Hepatol. 2013;11(11):1478-85.
16. Cheng CL, Liu NJ, Tang JH, Kuo YL, Hung HL, Tsui YN, et al. Predictors of Suboptimal Bowel Preparation Using 3-l of Polyethylene Glycol for an Outpatient Colonoscopy: A Prospective Observational Study. Dig Dis Sci. 2017;62(2):345-51.
17. Anderson JC, Butterly LF, Robinson CM, Goodrich M, Weiss JE. Impact of fair bowel preparation quality on adenoma and serrated polyp detection: data from the New Hampshire colonoscopy registry by using a standardized preparation-quality rating. Gastrointest Endosc. 2014;80(3):463-70.
18. Mahmood S, Farooqui SM, Madhoun MF. Predictors of inadequate bowel preparation for colonoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2018;30(8):819-26.
19. Gandhi K, Tofani C, Sokach C, Patel D, Kastenberg D, Daskalakis C. Patient Characteristics Associated With Quality of Colonoscopy Preparation: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2018;16(3):357-69.e10.
20. Yee R, Manoharan S, Hall C, Hayashi A. Optimizing bowel preparation for colonoscopy: what are the predictors of an inadequate preparation? Am J Surg. 2015;209(5):787-92; discussion 92.
21. Gimeno-Garcia AZ, Baute JL, Hernandez G, Morales D, Gonzalez-Perez CD, Nicolas-Perez D, et al. Risk factors for inadequate bowel preparation: a validated predictive score. Endoscopy. 2017;49(6):536-43.
22. Dik VK, Moons LM, Huyuk M, van der Schaar P, de Vos Tot Nederveen Cappel WH, Ter Borg PC, et al. Predicting inadequate bowel preparation for colonoscopy in participants receiving split-dose bowel preparation: development and validation of a prediction score. Gastrointest Endosc. 2015;81(3):665-72.
23. Lai EJ, Calderwood AH, Doros G, Fix OK, Jacobson BC. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc. 2009;69(3 Pt 2):620-5.
24. Blaha MJ. The Critical Importance of Risk Score Calibration: Time for Transformative Approach to Risk Score Validation? J Am Coll Cardiol. 2016;67(18):2131-4.
25. Parra-Blanco A, Nicolas-Perez D, Gimeno-Garcia A, Grosso B, Jimenez A, Ortega J, et al. The timing of bowel preparation before colonoscopy determines the quality of cleansing, and is a significant factor contributing to the detection of flat lesions: a randomized study. World journal of gastroenterology. 2006;12(38):6161-6.
26. Emmanuel A, Mattace-Raso F, Neri MC, Petersen KU, Rey E, Rogers J. Constipation in older people: A consensus statement. Int J Clin Pract. 2017;71(1).
27. Cameron AJ, Shaw JE, Zimmet PZ. The metabolic syndrome: prevalence in worldwide populations. Endocrinol Metab Clin North Am. 2004;33(2):351-75, table of contents.
28. Romero RV, Mahadeva S. Factors influencing quality of bowel preparation for colonoscopy. World J Gastrointest Endosc. 2013;5(2):39-46.
29. Borg BB, Gupta NK, Zuckerman GR, Banerjee B, Gyawali CP. Impact of obesity on bowel preparation for colonoscopy. Clin Gastroenterol Hepatol. 2009;7(6):670-5.
30. Sharara AI, Harb AH, Sarkis FS, Chalhoub JM, Habib RH. Body mass index and quality of bowel preparation: Real life vs. clinical trials. Arab J Gastroenterol. 2016;17(1):11-6.
31. Mushref MA, Srinivasan S. Effect of high fat-diet and obesity on gastrointestinal motility. Ann Transl Med. 2013;1(2):14.
32. Booth ML, Hunter C, Gore CJ, Bauman A, Owen N. The relationship between body mass index and waist circumference: implications for estimates of the population prevalence of overweight. Int J Obes Relat Metab Disord. 2000;24(8):1058-61.
33. Meier R, Beglinger C, Dederding JP, Meyer-Wyss B, Fumagalli M, Rowedder A, et al. Influence of age, gender, hormonal status and smoking habits on colonic transit time. Neurogastroenterol Motil. 1995;7(4):235-8.
34. Bohlin J, Dahlin E, Dreja J, Roth B, Ekberg O, Ohlsson B. Longer colonic transit time is associated with laxative and drug use, lifestyle factors, and symptoms of constipation. Acta Radiol Open. 2018;7(10):2058460118807232.
35. Dreher M. Whole fruits and fruit fiber emerging health effects. Nutrients. 2018;10(12):1833.
36. Yadlapati R, Johnston ER, Gregory DL, Ciolino JD, Cooper A, Keswani RN. Predictors of Inadequate Inpatient Colonoscopy Preparation and Its Association with Hospital Length of Stay and Costs. Dig Dis Sci. 2015;60(11):3482-90.
37. Chang JY, Locke GR, Schleck CD, Zinsmeister AR, Talley NJ. Risk factors for chronic constipation and a possible role of analgesics. Neurogastroenterol Motil. 2007;19(11):905-11.
38. Rotondano G, Rispo A, Bottiglieri ME, De Luca L, Lamanda R, Orsini L, et al. Quality of bowel cleansing in hospitalized patients undergoing colonoscopy: A multicentre prospective regional study. Dig Liver Dis. 2015;47(8):669-74.
39. Bjornsson ES, Chey WD, Hooper F, Woods ML, Owyang C, Hasler WL. Impaired gastrocolonic response and peristaltic reflex in slow-transit constipation: role of 5-HT(3) pathways. Am J Physiol Gastrointest Liver Physiol. 2002;283(2):G400-7.
40. Mawe GM, Hoffman JM. Serotonin signalling in the gut--functions, dysfunctions and therapeutic targets. Nature reviews Gastroenterology & hepatology. 2013;10(8):473-86.
41. Crowell MD. The role of serotonin in the pathophysiology of irritable bowel syndrome. Am J Manag Care. 2001;7(8 Suppl):S252-60.
42. Grover M, Camilleri M. Effects on gastrointestinal functions and symptoms of serotonergic psychoactive agents used in functional gastrointestinal diseases. J Gastroenterol. 2013;48(2):177-81.
43. Terry N, Margolis KG. Serotonergic Mechanisms Regulating the GI Tract: Experimental Evidence and Therapeutic Relevance. Handb Exp Pharmacol. 2017;239:319-42.
44. Cash BD, Chey WD. Review article: The role of serotonergic agents in the treatment of patients with primary chronic constipation. Aliment Pharmacol Ther. 2005;22(11-12):1047-60.
45. Lin YM, Sarna SK, Shi XZ. Prophylactic and therapeutic benefits of COX-2 inhibitor on motility dysfunction in bowel obstruction: roles of PGE(2) and EP receptors. Am J Physiol Gastrointest Liver Physiol. 2012;302(2):G267-75.
46. Smid SD, Svensson KM. Inhibition of cyclooxygenase-2 and EP1 receptor antagonism reduces human colonic longitudinal muscle contractility in vitro. Prostaglandins Other Lipid Mediat. 2009;88(3-4):117-21.
47. Cong P, Pricolo V, Biancani P, Behar J. Abnormalities of prostaglandins and cyclooxygenase enzymes in female patients with slow-transit constipation. Gastroenterology. 2007;133(2):445-53.
48. Jones RH, Tait CL. Gastrointestinal side-effects of NSAIDs in the community. Br J Clin Pract. 1995;49(2):67-70.
49. de Melo Jr S. Patients Come Clean: How Patient Factors and the Bowel Preparation Experience Influence Bowel Preparation Quality. Biomedical Journal of Scientific & Technical Research. 2018;7.
50. Peters HP, De Vries WR, Vanberge-Henegouwen GP, Akkermans LM. Potential benefits and hazards of physical activity and exercise on the gastrointestinal tract. Gut. 2001;48(3):435-9.
51. Dukas L, Willett WC, Giovannucci EL. Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women. Am J Gastroenterol. 2003;98(8):1790-6.
52. De Schryver AM, Keulemans YC, Peters HP, Akkermans LM, Smout AJ, De Vries WR, et al. Effects of regular physical activity on defecation pattern in middle-aged patients complaining of chronic constipation. Scandinavian Journal of Gastroenterology. 2005;40(4):422-9.
- Abstract Viewed: 0 times
- pdf Downloaded: 0 times