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

Mahmood, Sultan; Farooqui, Samid M.; Tajammal, Rutaba; Nusrat, Salman; Madhoun, Mohammad F.

doi:10.1016/s0016-5085(17)32543-x

Cited by 29 publications

(49 citation statements)

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“…Overall, 87.9% of our patients achieved adequate preparation. This result is in line or superior to the results reported in the literature (24,25), even if slightly inferior to the 90% target proposed by the European Society of Gastrointestinal Endoscopy (ESGE) in 2019 (26). We con rmed that the low-volume PEG plus bisacodyl preparation is equally effective than HV in all the colonic segments (while some studies have shown worse performances of low-volume preparations in the right colon (27)) and irrespective of the intake schedule.…”

Section: Discussionsupporting

confidence: 85%

Efficacy and Tolerability of High and Low-volume Bowel Preparation Compared: a Real-life Single-blinded Large-population Study

Occhipinti

Soriani

Bagolini

et al. 2020

Preprint

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Background: Low-volume (LV) preparations for colonoscopy have shown similar efficacy compared to high-volume (HV) ones in trials. However, real-life clinical outcomes data are lacking. Our aim was to assess patients’ free choice among HV preparations (4L polyethylene glycol, PEG) and LV (2L PEG plus bisacodyl) and to compare efficacy and tolerability. Methods: Consecutive outpatients referred for colonoscopy could choose either LV or HV preparation with schedules (day-before or split-dose) depending on their appointment time. Adequate bowel preparation according to Boston Bowel Preparation Scale, clinical outcomes and self-reported tolerability of HV and LV were blindly assessed.Results: 2,040 patients were enrolled and 1,815 (age 60.6 years, 50.2% men) finally included. LV was chosen by 52% of patients (50.8% of men, 54.9% of women). Split-dose schedule was more common with HV (44.7% vs. 38.2%, p=0.0055). HV and LV preparations showed similar adequate bowel preparation rates (89.2% vs. 86.6%, p=0.0983) but HV ones resulted higher in detection rates for polyps (PDR; OR 1.30, 95% CI 1.03–1.64, p=0.0254), adenomas (ADR; OR 1.28, 95% CI 0.99–1.65, p=0.0519) and advanced adenomas (AADR; OR 1.54, 95% CI 0.96–2.46, p= 0.0723) after adjustment for sex, age, indications. Visual Analogue Scale tolerability scored equally (7 [5-9]) but a ≥75% dose intake was more frequent with LV.Conclusions: in a real-life setting, LV preparation confirms similar efficacy and tolerability compared to HV. However, with higher PDR and a trend toward higher ADR and AADR, HV should still be considered the reference standard for clinical trials.

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Section: Discussionsupporting

confidence: 85%

Efficacy and Tolerability of High and Low-volume Bowel Preparation Compared: a Real-life Single-blinded Large-population Study

Occhipinti

Soriani

Bagolini

et al. 2020

Preprint

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“…The possible reason was that the patient sources in our study were from outpatient, inpatient, and emergent department. In addition, the patients may have higher rate of comorbidities such as diabetes mellitus, hypertension, heart failure coronary artery disease, stroke, chronic kidney disease, liver cirrhosis and malignancy disease, which may affect the colon preparation results . However, our endoscopic databases were not linked to patients' underlying condition.…”

Section: Discussionmentioning

confidence: 88%

“…In addition, the patients may have higher rate of comorbidities such as diabetes mellitus, hypertension, heart failure coronary artery disease, stroke, chronic kidney disease, liver cirrhosis and malignancy disease, which may affect the colon preparation results. 30,31 However, our endoscopic databases were not linked to patients' underlying condition. Finally, pathological data were not presented in our study due to the fact that this study was not linked to pathological databases, and we were unable to evaluate the ADR.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with polyp detection during colonoscopy: A retrospective observational study

Chen

Chiu

et al. 2019

The Kaohsiung J of Med Scie

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The polyp detection rate (PDR) is an important quality indicator for colonoscopy. Several factors have been shown to be associated with PDR. However, whether the moderate sedation is a factor for polyp detection remains controversial. This study aims to assess factors associated with polyp detection including the moderate sedation factor during colonoscopy. Patients who underwent colonoscopy from June 1, 2014 to May 31, 2015 were enrolled into this retrospective study. Patients with poor colon preparation and failure to reach the cecum were excluded. The clinical factors, including patient's sex, age, midazolam/fentanyl sedation, indications, endoscopist colonoscopy volume, and use of antispasmodic agent were evaluated by multivariate analysis. A total of 3373 patients were included in this study. The mean age was 55.8 years, and 1980 patients (58.7%) were male. Among the 3373 patients, 2513 (74.5%) underwent midazolam/fentanyl‐based sedated colonoscopy. The multivariate analysis showed that male sex, age over 50 years old, midazolam/fentanyl sedation and indications of screening and surveillance were significantly associated with polyp detection. Moreover, when stratified by sex and age, the midazolam/fentanyl sedation was associated with polyp detection in male patients and patients over 50 years old. This study has highlighted the role of midazolam/fentanyl sedation administered by colonoscopists as a modifiable factor that may increase polyp detection during colonoscopy.

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“…Another prospective study of 2811 patients undergoing colonoscopy identified Parkinson's disease as a risk factor for inadequate BP with an OR of 3.2 . Additionally, a large meta‐analysis of 49,868 patients identified stroke as a risk factor for inadequate BP . Perhaps this association between neurologic disease and poor BP is related to decrease in colonic motility secondary to patient immobility, giving rise to constipation .…”

Section: Discussionmentioning

confidence: 99%

“…9 In contrast, the current cohort identified an association only in those patients whose di- 16 Additionally, a large meta-analysis of 49,868 patients identified stroke as a risk factor for inadequate BP. 17 Perhaps this association between neurologic disease and poor BP is related to decrease in colonic motility secondary to patient immobility, giving rise to constipation. 18 Dehydration could also contribute to constipation in this population with inadequate oral intake secondary to dysphagia or impaired thirst mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Modelling characteristics of inadequate bowel preparations for colonoscopy

et al. 2020

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Background and Aims Colonoscopy remains the gold standard for colon cancer screening, but poor bowel preparation (BP) results in an inadequate examination. We sought to determine factors associated with poor BP. Methods In this prospective quality improvement study, data were serially gathered from 649 patients prior to colonoscopy at an academic medical centre with using a survey. Recipients with adequate BP were compared to those with inadequate BP. Results Bowel preparation was inadequate in 20.9% (N = 136) of colonoscopies. Risk factors for inadequate BP included male gender (OR 2.1, 95% CI 1.3‐3.4, P = 0.0039), chronic obstructive pulmonary disease (COPD) (OR 3.9, 95% CI 1.9‐7.9, P = 0.0002), diabetes mellitus with end‐organ damage (OR 11.7, 95% CI 5.6‐24.6, P < 0.0001), severe neurologic disease (OR 5.1, 95% CI 2.2‐11.8, P < 0.0002), medications to treat constipation (OR 2.0, 95% CI 1.2‐3.5, P = 0.0129), tricyclic antidepressant use (OR 7.5, 95% CI 3.1‐18.4, P < 0.0001), non‐utilization of a split prep (OR 5.3, 95% CI 3.1‐9.0, P < 0.0001), incomplete BP (OR 3.5, 95% CI 2.0‐6.3, P < 0.0001) and non‐adherence to clear liquid diet instructions (OR 4.3, 95% CI 2.2‐8.6, P < 0.0001). Modelling inadequate preparation with these variables demonstrated an area under the receiver operating curve of 0.8525 indicating utility in predicting inadequate BP. Conclusions The likelihood of inadequate BP is strongly influenced by advanced medical comorbidities, medications and type of BP. This information can help determine which patients are at higher risk for inadequate BP and may allow providers to adjust the prescribed BP leading to improved colonoscopy visualization, reduced procedure time and reduced healthcare costs.

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

Cited by 29 publications

References 0 publications

Efficacy and Tolerability of High and Low-volume Bowel Preparation Compared: a Real-life Single-blinded Large-population Study

Efficacy and Tolerability of High and Low-volume Bowel Preparation Compared: a Real-life Single-blinded Large-population Study

Factors associated with polyp detection during colonoscopy: A retrospective observational study

Modelling characteristics of inadequate bowel preparations for colonoscopy

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