Risk Factors of Inadequate Bowel Preparation for Screening Colonoscopy

Abstract

The success of a colonoscopy in detecting and removing pre-cancerous and cancerous lesions depends heavily on the quality of bowel preparation. Despite efforts, 20–44% of colonoscopy participants have an inadequate bowel preparation. We aimed to assess and compare risk factors for inadequate bowel preparation and for the presence of advanced colorectal neoplasms in routine screening practice. In this cross-sectional study, among 8125 participants of screening colonoscopy in Germany with a comprehensive assessment of sociodemographic factors, lifestyle and medical history, we examined factors associated with inadequate bowel preparation and with findings of advanced neoplasms using adjusted log-binomial regression models. Among the identified risk factors assessed, three factors were identified that were significantly associated with inadequate bowel preparation: age ≥ 70 years (adjusted prevalence ratios, aPR, 1.50 95%CI 1.31–1.71), smoking (aPR 1.29 95%CI 1.11–1.50) and abdominal symptoms (aPR 1.14 95%CI 1.02–1.27). The same risk factors were also associated with the prevalence of advanced neoplasms in our study (aPR 1.72, 1.62 and 1.44, respectively). The risk factors associated with inadequate bowel preparation in this study were also associated with a higher risk for advanced neoplasms. Inadequate bowel preparation for colonoscopy might lead to missed colorectal cancer (CRC) precursors and the late diagnosis of CRC. People at high risk of advanced neoplasms are in particular need of enhanced bowel preparation.

The effectiveness of walking exercise on the bowel preparation before colonoscopy: A single blind randomized clinical trial study

“…In addition, in our study, smoking was another risk factor for poorer bowel preparation. Other studies also con rm this nding[76,77]. It is assumed that smokers are less likely to follow the instruction before colonoscopy precisely due to lower socioeconomic and health status [78].…”

Medical and social risk factors for inadequate bowel preparation prior to colonoscopy

“…Although alcohol use was not found to be a risk factor for inadequate bowel preparation in our study, tobacco use was. Tobacco use has been noted to be a risk factor for poor bowel preparation in other studies but the mechanism for this phenomenon is again likely multifactorial [11]. Effects of nicotine in the gastrointestinal tract include damage to the mucosal integrity of the bowel wall and changes in the mucus and microbiota of the bowel lumen [12].…”

Comparison of Two Types of 1-L Polyethylene Glycol-ascorbic Acid as Colonoscopic Bowel Preparation: A Prospective Randomized Study

“…3,7 Many factors affect the quality of the colonoscopy besides bowel preparation agents, such as patients' age, degree of physical activity, adherence to instructions, underlying disease, continuing medical education of the endoscopist, instrument quality, and withdrawal times. 6,27,28 On the other hand, among the several factors mentioned, the bowel cleansing agent is considered the most important factor, and the discomfort experienced in the bowel preparation process affects patient compliance.…”

“…this is a major cause of interval cancer. [5][6][7] Patient compliance with bowel cleansing agents and efficacy are correlated with the adequacy of bowel preparation. 8 Therefore, efforts have been made to develop bowel cleansing agents with a low volume for patient compliance.…”