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

Fang, Jun; Fang, Hong; Ma, Dan; Wang, Dong; Liu, Ya Ping; Wang, Yun Feng; Zhu, Charlene; Qian, Wei; Bai, Yu; Li, Zhao Shen

doi:10.1111/1751-2980.12376

Cited by 33 publications

(30 citation statements)

References 29 publications

(36 reference statements)

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“…conducted a multivariate analysis showing that patients who do not take the entire preparation dose are more likely to have inadequate bowel preparation (OR, 4.34; CI, 1.08–16.66). [ 22 ] Recently, several studies have confirmed that complete preparation is an important factor for a satisfactory bowel preparation,[ 9 20 ] and a similar conclusion may be drawn from our study. Therefore, future studies to determine methods for ensuring that patients complete the preparation medication are worthwhile.…”

Section: Discussionsupporting

confidence: 90%

“…We also found that elderly patients with chronic constipation had a higher risk of inadequate bowel preparation than those with no history of constipation, which was similarly reported by Fang et al . [ 20 ] This may be attributed to the diminished intestinal motility in elderly patients that, in combination with chronic constipation, could lead to an intestinal emptying disorder and a large amount of residual stool in the bowel after the preparation.…”

Section: Discussionmentioning

confidence: 99%

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The incidence of and risk factors for inadequate bowel preparation in elderly patients: A prospective observational study

Zhang¹,

Niu²,

Z³

et al. 2018

Saudi J Gastroenterol

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Background/Aim:We conducted a prospective observational study to identify the incidence of and risk factors for inadequate bowel preparation in elderly Chinese patients.Patients and Methods:We enrolled 240 outpatients over 60 years of age scheduled for elective colonoscopy at our university hospital between November 2016 and April 2017. We recorded patient demographics, bowel preparation data, and clinical characteristics. Factors associated with inadequate bowel preparation were identified by multivariate logistical regression analysis.Results:The rate of inadequate bowel preparation was 34.6%. Factors associated with inadequate bowel preparation were a history of abdominal surgery (OR, 2.617; CI, 1.324–5.174; P = 0.006), chronic constipation (OR, 3.307; CI, 1.551–7.054; P = 0.002), non-compliance with dietary instructions (OR, 2.239; CI, 1.122–4.471; P = 0.022), non-compliance with polyethylene glycol (PEG) dosage (OR, 4.576; CI, 1.855–11.287; P = 0.001), walking <30 minutes during preparation (OR, 2.474; CI, 1.261–4.855; P = 0.008), interval between PEG ingestion and the onset of bowel activity (OR, 1.025; CI, 1.010–1.040; P = 0.001), and a last stool that was not clear and watery (OR, 4.191; CI, 1.529–11.485; P = 0.005).Conclusion:The incidence of adequate bowel preparation in elderly patients is not optimal. Walking <30 minutes during the PEG ingestion period may be a surrogate for bowel preparation failure. Future studies should identify elderly patients at risk for poor bowel preparation and develop interventions to improve outcomes in this population.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

The incidence of and risk factors for inadequate bowel preparation in elderly patients: A prospective observational study

Zhang¹,

Niu²,

Z³

et al. 2018

Saudi J Gastroenterol

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“…DM along with gastrointestinal motility anomalies in accordance with our expectations may be independent risk factors of inadequate bowel preparation. The high-FODMAP diet plays the same role as a high-fiber diet [18] and is significantly associated with poor bowel cleansing efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Limitations of our study are worth noting. As this was a multicenter study, interobserver variability among endoscopists may have affected our results; however, we used the bubble score and BBPS to evaluate the quality of bowel cleansing, as have been commonly used in our previous study [17,18] that showed excellent interobserver agreement. In this study, two experienced endoscopists scored bowel preparation in each center.…”

Section: Discussionmentioning

confidence: 99%

“…The primary endpoints of this study included the Boston bowel preparation scale (BBPS) score, which was developed to evaluate the quality of colon preparation and was used in our previous study [17,18]. Points (segment score) were assigned as follows: 0, unprepared colon segment; 1, major residual stool or opaque liquid; 2, minor residual staining; and 3, entire mucosa easily visible.…”

Section: Endpointsmentioning

confidence: 99%

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Effect of the High-FODMAP Diet on Bowel Preparation for Colonoscopy: A Multicenter, Prospective Cohort Study

Peng

Wang

et al. 2020

Gastroenterology Research and Practice

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Background. Optimal bowel preparation for colonoscopy is fundamental to a successful examination. The FODMAP diet can increase the content of intestinal water and gas, but its impact on bowel cleanliness and bubbles has not been reported. This study was therefore aimed at evaluating the effect of the FODMAP diet on the quality of bowel preparation and the adenoma detection rate (ADR). Methods. This was a multicenter, prospective cohort study involving consecutive patients who underwent colonoscopy in two centers in China. Patients were assigned to one of two groups: high-FODMAP or nonhigh-FODMAP diet. ODMP Software was used for the identification of FODMAP diet types. The primary outcome was ADR; secondary outcomes were the quality of bowel preparation, measured by the Boston bowel preparation scale and bubble scores. Results. There were 365 patients included. Patients in the high-FODMAP-diet group showed poor bowel cleansing efficacy: BBPS≥6 in 76.8% vs. 90.3% (P<0.01) and bubble scores of 2.42±1.69 vs. 1.32±1.63 (P<0.001). The intubation time was significantly longer in the high-FODMAP-diet group (7.07±5.18 vs. 5.46±3.05 min; P=0.002). The High-FODMAP diet was an independent risk predictor for inadequate bowel preparation. There were no statistically significant differences in ADR between the two dietary groups. Conclusion. The high-FODMAP diet significantly reduced the quality of bowel preparation. We recommend the consumption of nonhigh-FODMAP diet in bowel preparation as a reference standard for dietary regimen. This method was effective, flexible, referable, and well tolerated, which could help to provide patients a valuable dietary guidance in bowel preparation.

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Effect of Text Messaging on Bowel Preparation and Appointment Attendance for Outpatient Colonoscopy

et al. 2021

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IMPORTANCEOutpatient colonoscopy is important for colorectal cancer screening. However, nonadherence and poor bowel preparation are common. OBJECTIVE To determine if an automated text messaging intervention with a focus on informational and reminder functions could improve attendance rates and bowel preparation quality for outpatient colonoscopy. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted in an endoscopy center at an urban academic medical center. Adult patients scheduled for outpatient colonoscopy between January and September 2019 were enrolled by telephone call (early phase) or by automated text message (late phase). Data were analyzed from October 2019 to January 2020. INTERVENTIONSAfter enrollment, patients were randomized in a 1:1 ratio to usual care (ie, written instructions and nurse telephone call) or to the intervention (ie, usual care plus an automated series of 9 educational or reminder text messages in the week prior to scheduled colonoscopy). MAIN OUTCOMES AND MEASURESThe primary outcome was appointment attendance rate with good or excellent bowel preparation. Secondary outcomes included appointment attendance rate, bowel preparation quality (poor or inadequate, fair or adequate, and good or excellent), and cancellation lead time (in days). RESULTS Among 753 patients included and randomized in the trial (median [interquartile range]age, 56 [49-64] years; 364 [48.3%] men; 429 [57.2%] Black), 367 patients were randomized to the intervention group and 386 patients were randomized to the control group. There was no significant difference in the primary outcome between groups (patients attending appointments with good or excellent bowel preparation: intervention, 195 patients [53.1%]; control, 210 patients [54.4%]; P = .73), including when stratified by early or late phase enrollment groups. Similarly, there were no significant differences in secondary outcomes. CONCLUSIONS AND RELEVANCEThis randomized clinical trial found no significant difference in appointment attendance or bowel preparation quality with an automated text messaging intervention compared with the usual care control. Future work could optimize the content and delivery of text message interventions or identify patient subgroups that may benefit from this approach.

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

Abstract: 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.

Cited by 33 publications

References 29 publications

The incidence of and risk factors for inadequate bowel preparation in elderly patients: A prospective observational study

The incidence of and risk factors for inadequate bowel preparation in elderly patients: A prospective observational study

Effect of the High-FODMAP Diet on Bowel Preparation for Colonoscopy: A Multicenter, Prospective Cohort Study

Effect of Text Messaging on Bowel Preparation and Appointment Attendance for Outpatient Colonoscopy

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