Risk factors for inadequate bowel preparation: a validated predictive score

Abstract

Inadequate bowel cleansing negatively affects the efficiency of colonoscopy in routine clinical practice. The aim of this study was to design and validate a predictive model for inadequate bowel cleanliness. The model was built from 667 consecutive outpatients (development cohort) who were prospectively scheduled for colonoscopy between June and September 2014. The validation cohort included 409 outpatients who underwent colonoscopy between October and December 2014. Cleansing was evaluated using the Boston Bowel Preparation Scale (BBPS). Bowel preparation was administered on the same day as the examination. In the development cohort, BBPS was adequate in 541 patients (81.1 %). At multivariate analysis, antidepressants (odds ratio [OR] 4.25, 95 % confidence interval [CI] 1.91 - 9.47), co-morbidity (OR 3.35, 95 %CI 2.16 - 5.18), constipation (OR 2.09, 95 %CI 1.29 - 3.40), and abdominal/pelvic surgery (OR 1.60, 95 %CI 1.03 - 2.47) were independent predictors for inadequate cleansing. The model built with these variables showed an area under the curve of 0.72 in the development cohort and 0.70 in the validation cohort. A cutoff of 1.225 predicted inadequate bowel preparation with a sensitivity, specificity, positive predictive value, and negative predictive value of 60.3 % (95 %CI 51.6 - 68.4), 75.4 % (95 %CI 71.6 - 78.9), 36.4 % (95 %CI 30.1 - 43.1), and 89.1 % (95 %CI 85.9 - 91.6) in the development cohort, and 50.0 % (95 %CI 38.1 - 61.9), 80.0 % (95 %CI 75.3 - 84.2), 35.7 % (95 %CI 26.4 - 45.6), and 87.9 % (95 %CI 83.7 - 91.3) in the validation cohort. A simple score may assist the clinician in predicting which patients are at high risk of inadequate bowel cleanliness. This may guide changes in bowel preparation strategy accordingly.

Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type

“…There is agreement that there are three main explanations for post-colonoscopy CRC: missed advanced neoplasia, new lesions and incompletely resected lesions. The most important factor related to missed advanced neoplasia is the ADR, which in turn depends on cecal intubation rate, withdrawal time, and colon cleansing 15 18 21 22 23 24 25 26 27 . All these factors are interrelated.…”

Comparison of the effect of 1-day and 2-day low residue diets on the quality of bowel preparation before colonoscopy

“…Current studies have shown that adequate bowel preparation is related to the following factors: type of diet and laxatives, time between taking the last laxative dose and the colonoscopy, ability to comply or tolerate bowel preparation, and non-split dose or split dose of laxatives. [ 2 3 4 5 ] Limiting the type of diet can reduce the amount of stool in the intestines. Previously, it was a common practice to limit patients to a clear liquid diet (CLD) for 1 day before colonoscopy, but this practice significantly increased the hunger sensation of patients, greatly reduced patient compliance and comfort, and even caused hypoglycaemia.…”

Strategies to Improve Inadequate Bowel Preparation for Colonoscopy

“…Conversely, family history of CRC or personal history of polyps have been associated with better quality of bowel cleansing attributed to a higher motivation (29). Moreover, conditions associated with delayed colonic transit such as constipation (5, 49, 50), altered bowel anatomy due to previous abdominal or pelvic surgery (5) (including colorectal resection, mainly left resections) (5, 47, 51), drugs (tricyclic antidepressant, opioids or calcium antagonists) (5, 49), or comorbidities such as diabetes (5, 29, 47, 49) have been reported to be risk factors for inadequate bowel preparation. Physical activity restrictions due to obesity (47) and comorbidities have also been reported to be risk factors for poor bowel cleansing (5).…”

“…However, up to 30% of diagnostic colonoscopies are reported to have an inadequate bowel cleasing (4). Recently, several studies have assessed risk factors associated with an inadequate bowel preparation, suggesting that more research is warranted on new strategies to improve bowel cleansing (5). This review aimed to analyze these recommendations, placing special attention on patients that have an increased risk of inadequate bowel preparation.…”