Predictors of inadequate bowel preparation for colonoscopy: a systematic review and meta-analysis

Abstract

The aim of this study was to investigate factors contributing to poor bowel preparation in patients undergoing colonoscopy procedures. We used a reproducible search strategy to identify studies, searching 10 medical databases, including PubMed, Ovid, Medline, and Cochrane Library Database for reports published between 2000 and 2016. Fully published studies, evaluating risk factors for inadequate bowel preparation, were included. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. Pooling was conducted with both fixed-effects and random-effects models; results were presented from the random effects model when heterogeneity was significant. Odds ratios (OR) estimates with 95% confidence interval were calculated. Heterogeneity was assessed by I statistics. Twenty-four studies with a total of 49 868 patients met the inclusion criteria. Age (OR: -1.20), male sex (OR: 0.85), inpatient status (OR: 0.57), diabetes mellitus (OR: 0.58), hypertension (OR: 0.58), cirrhosis (OR: 0.49), narcotic use (OR: 0.59), constipation (OR: 0.61), stroke (OR; 0.51), and tricyclic antidepressant (TCA) use (0.51), were associated with inadequate bowel preparation. In our sensitivity analysis comparing Western and Asian countries, we found that diabetes, cirrhosis, male sex, history of stroke and TCA use were stronger risk factors for inadequate bowel preparation in Western countries than in Asian countries. We also found that history of stroke, TCA use, and race were risk factors for inadequate bowel preparation in patients receiving conventional bowel preparation compared with those receiving split-dose bowel preparation. Multiple risk factors affect the quality of bowel preparation and specific risk factors can be intervened upon, in different populations, to optimize preparation.

Predictors and colonoscopy outcomes of inadequate bowel cleansing: a 10-year experience in 28,725 patients

“…In the current study, we demonstrated that several of the indications of the procedure and the clinical settings were linked with poor preparation. Constipation was significantly associated with inadequate cleansing (OR 1.373, 95%CI 1.24-1.519; P<0.01), consistent with similar findings from other studies [32]. Likewise, patients with rectal bleeding were less adequately prepared (OR 1.473, 95%CI 1.355-1.602; P<0.01), apparently because of the urgent nature of procedures in this setting.…”

Improving the quality of bowel preparation through an app for inpatients undergoing colonoscopy: A randomized controlled trial

“…This study suggested that male sex was associated with an increased risk of suboptimal colon preparation, in line with prior findings (Cheng et al, ; Lebwohl, Wang, & Neugut, ). A possible explanation was that compliance with taking laxatives is poorer among men than among women (Lebwohl et al, ; Mahmood et al, ). Furthermore, constipation is considered an independent risk factor for inadequate colon preparation (Cheng et al, ), which is inconsistent with the findings of our study.…”

“…According to previous studies, 12-22% of excess colonoscopy-related costs are due to suboptimal bowel preparation (Byrne, 2002). Hospitalized patients are at a higher risk for poor bowel preparation than outpatients because they are generally older and weaker (Chorev et al, 2007;Mahmood, Farooqui, & Madhoun 2018;Mcnabb-Baltar et al, 2016). One prior study revealed that the rate of adequate bowel preparation was only 50% in hospitalized patients (Ness et al, 2001).…”

Can a 1-day clear liquid diet with a split -dose polyethylene glycol overcome conventional practice patterns during the preparation for screening colonoscopy?

“…An adequate bowel preparation is essential in providing satisfactory visualization of the colonic mucosa, to optimize lesion detection, and to make a safe therapeutic intervention (2)(3)(4). Despite this, unfortunately, many patients cannot comply with the bowel cleaning regimens because of strict dietary modifications that affect their preprocedural quality of life and the large volume of flavorless laxative solutions (5,6). Moreover, patients having an inadequate bowel cleaning need to repeat similar preparation steps before the next examination (6,7).…”

“…Moreover, patients having an inadequate bowel cleaning need to repeat similar preparation steps before the next examination (6,7). This also means that the risks associated with endoscopic investigation and anesthesia increase, and the procedure cost doubles (5,7).…”