2888 Hospitalization for Colonoscopy Preparation and Its Effects on Prep Quality

Abstract

INTRODUCTION: Colonoscopy is the most commonly used method for colon cancer screening. The quality of prep greatly affects the examination. Risk factors for inadequate prep include prior inadequate prep, male gender, prior surgery, diabetes, low health literacy and cognitive delay. Studies have shown improvement in colonoscopy prep using split-dosing however despite this, inadequate prep continues to be a problem. One solution at our institution is to hospitalize selected patients with prior failed outpatient colonoscopy prep in an attempt to improve the prep quality. METHODS: We retrospectively identified all patients who were hospitalized for colonoscopy prep from 2016 to 2018. Patients who did not have documentation of prep quality were excluded. Data including age, gender, indication for procedure and presence of risk factors was gathered. The prior prep quality and prep quality after admission was documented. RESULTS: 122 patients were included in the study. “Screening” was the most common indication for the procedure. Most of the patients had at least one risk factor for inadequate prep. 90 patients had improvement in their prep quality. CONCLUSION: Bowel prep continues to be inadequate in up to 25% of examinations. Several patient related risk factors for inadequate prep have been identified in previous studies. Patients who have risk factors for slow bowel transit such as immobility, CVA and chronic use of narcotics can also be factors in colon prep. We believe the improvement in bowel prep in our study is related to adherence to dietary restrictions, accurate laxative consumption, and improved assessment of stool clearance. Our study also showed a significant number of improved bowel prep quality in patients who had risk factors for poor prep. The cost of hospitalization was not evaluated in our study. We believe that an adequate bowel would result in a longer time-interval for subsequent colonoscopies and reduced overall cost. Our study is limited given its retrospective design and small number of patients. In addition, given that our software does not allow use of the Boston Bowel Prep Scale, the results may be difficult to generalize to other populations. Repeat studies would be needed to assess cost effectiveness. Quality of bowel prep continues to be a barrier to high quality colonoscopy. This study shows that hospitalized bowel prep may help improve prep quality in a select group of patients in the underserved population and with known risk factors.