Factors influencing quality of bowel preparation for colonoscopy

Abstract

Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance. However, the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy. Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance, such as reduced cecal intubation rates, increased patient discomfort and lower adenoma detection. The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte, a non-absorbable solution, or aqueous sodium phosphate, a lowvolume hyperosmotic solution. Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar, although patients' compliance with these regimes may differ somewhat. Many studies have now shown that factors other than the type of bowel preparation regime used, can influence the quality of bowel preparation among adult patients undergoing colonoscopy. These factors can be broadly categorized as either patient-related or procedure-related. Studies from both Asia and the West have identified patient-related factors such as an increased age, male gender, presence of co-morbidity and socioeconomic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy. Additionally, procedure-related factors such as adherence to bowel preparation instructions, timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing. Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly, such that the quality of colonoscopy performance and delivery of service to patients can be optimised.

Split-dose Bowel Preparation for Colonoscopy: 2 Liters Polyethylene Glycol with Ascorbic Acid versus Sodium Picosulfate versus Oral Sodium Phosphate Tablets

“…[16][17][18] Suspected reasons are reduced colon transit time or comorbidities in elderly patients. 19 A complex administration method is a barrier and could be the reason for poor adherence to the instruction of taking preparation agents in elderly patients. Detailed instructions and counseling could promote successful bowel cleansing.…”

Single‐day sodium picosulfate and magnesium citrate versus split‐dose polyethylene glycol for bowel cleansing prior to colonoscopy: A prospective randomized endoscopist‐blinded trial

“…Furthermore, patients using PMC received both sachets on the day before colonoscopy. It has been shown that timing has major influence on the quality of bowel preparation . Moreover, PEG given as a split dose seems to be more effective than a before day‐only administration .…”

Factors associated with colorectal cancer occurrence after colonoscopy that did not diagnose colorectal cancer

“…Elderly patients are more likely to have inadequate bowel preparation, thus reducing mucosal visualization and detection of polyps and early CRC. 22,23 Female patients are more likely to have had previous abdominal and pelvic surgery, which may increase the technical difficulty of colonoscopy and impair patient tolerance, reducing the cecal intubation rate. 24 In addition to factors that have an adverse effect on the cecal intubation rate, right side of the colon CRCs are more likely to arise from flat, non-polypoid adenomatous lesions 20,25 that are more difficult to detect with poor bowel preparation.…”