Predictors of inadequate bowel preparation for colonoscopy

OBJECTIVE: Inadequate preparation of the bowel for colonoscopy can result in both missed pathological lesions and cancelled procedures. We looked prospectively at the quality of colonic preparation and evaluated potential associations between specific patient characteristics and inadequate colonic preparation. METHODS: Data were gathered on consecutive patients presenting for colonoscopy who received either a polyethylene glycol lavage or oral sodium phosphate bowel preparation. Patient demographic and medical history information was gathered before scheduled colonoscopy. The endoscopist evaluated the preparation quality during the procedure. Complete data were gathered on 649 of 714 eligible patients (90.8%). Possible predictors of inadequate colonic preparation were analyzed using univariate statistics and multivariate logistic regression models. RESULTS: An inadequate colonic preparation was reported in 21.7% of observed colonoscopies. Only 18% of patients with an inadequate colonic preparation reported a failure to adequately follow preparation instructions. A later colonoscopy starting time, a reported failure to follow preparation instructions, inpatient status, a procedural indication of constipation, taking tricyclic antidepressants, male gender, and a history of cirrhosis, stroke or dementia were all independent predictors of an inadequate colon preparation (all p < 0.05). A procedural indication of previous polypectomy was a negative predictor of inadequate colonic preparation (p < 0.05). CONCLUSION: Several patient characteristics were significantly associated with colonic preparation quality independent of preparation type, compliance with preparation instructions, and procedure starting time. This information may help to identify patients at an increased risk for inadequate colonic preparation for whom alternative preparation protocols would be appropriate.     

Predictors of suboptimal bowel preparation in asymptomatic patients undergoing average-risk screening colonoscopy

AIM To identify risk factors for a suboptimal preparation among a population undergoing screening or surveillance colonoscopy.METHODS Retrospective review of the University of Michigan and Veteran's Administration(VA) Hospital records from 2009 to identify patients age 50 and older who underwent screening or surveillance procedure and had resection of polyps less than 1 cm in size and no more than 2 polyps. Patients with inflammatory bowel disease or a family history of colorectal cancer were excluded. Suboptimal procedures were defined as procedure preparations categorized as fair, poor or inadequate by the endoscopist. Multivariable logistic regression was used to identify predictors of suboptimal preparation.RESULTS Of 4427 colonoscopies reviewed, 2401 met our inclusion criteria and were analyzed. Of our population, 16% had a suboptimal preparation. African Americans were 70% more likely to have a suboptimal preparation(95%CI: 1.2-2.4). Univariable analysis revealed that narcotic and tricyclic antidepressants(TCA) use, diabetes, prep type, site(VA vs non-VA), and presence of a gastroenterology(GI) fellow were associated with suboptimal prep quality. In a multivariable model controlling for gender, age, ethnicity, procedure site and presence of a GI fellow, diabetes [odds ratio(OR) = 2.3; 95%CI: 1.6-3.2], TCA use(OR = 2.5; 95%CI: 1.3-4.9), narcotic use(OR = 1.7; 95%CI: 1.2-2.5) and Miralax-Gatorade prep vs 4L polyethylene glycol 3350(OR = 0.6; 95%CI: 0.4-0.9) were associated with a suboptimal prep quality. CONCLUSION Diabetes, narcotics use and TCA use were identified as predictors of poor preparation in screening colonoscopies while Miralax-Gatorade preps were associated with better bowel preparation.     

基于不同肠段的结肠镜检查人群肠道准备失败现状及影响因素分析

目的研究不同肠段发生肠道准备失败的现状, 并分析其影响因素。方法选取2021年12月—2023年1月在北京协和医院消化内镜中心进行结肠镜检查的677例患者作为研究对象, 患者均采用3 L聚乙二醇电解质散分次剂量的标准化肠道准备方案, 以波士顿肠道准备评分量表对患者的肠道准备情况进行评估, 并通过Logistic回归模型分析不同肠段发生肠道准备失败的影响因素。结果结肠镜检查人群的肠道准备不合格率为31.5%(213/677), 在肠道准备失败人群中, 仅近端肠道失败占85.4%(182/213), 全肠道失败占14.1%(30/213), 仅远端肠道失败仅占0.5%(1/213)。将仅远端肠道失败与全肠道失败合并为发生远端肠道准备失败, Logistic回归分析结果显示:男性(P=0.001, OR=2.253, 95%CI:1.399～3.629)、门诊患者(P<0.001, OR=4.175, 95%CI:2.410～7.231)、无结直肠癌家族史(P=0.001, OR=2.117, 95%CI:1.365～3.284)以及因诊断行结肠镜检查(P=0.003, OR=1.97...     

Retrospective analysis of missed advanced adenomas on surveillance colonoscopy

OBJECTIVE: Miss rates of large polyp/cancer during colonoscopy are reported from tertiary centers where experts do the colonoscopies. This information is important for determining surveillance intervals for repeat colonoscopy, patient safety, and malpractice issues. We evaluated retrospectively the miss rates of advanced adenomas in the setting of a GI fellowship training where most colonoscopies are done by closely supervised fellows. METHODS: We reviewed the 235 patients who had at least one repeat colonoscopy after initial polypectomy, between 1992 and 1999, at the Dayton Veterans Affairs Medical Center. Advanced adenomas were defined as polyps 10 mm or greater in size with or without a villous component or high-grade dysplasia. Data of missed advanced adenomas on 122 patients who had complete colonoscopy with satisfactory preparation and the excluded patients are reported. RESULTS: Four advanced adenomas (one had intramucosal cancer) on second colonoscopy and two advanced adenomas on third colonoscopy were missed. The miss rate of advanced adenoma for 232 patients was 1.7%, and the miss rate for the 122 patients with complete colonoscopy and satisfactory colon preparation was 2.5% and 3.3% on second and third repeat colonoscopy, respectively. No cancer was missed. CONCLUSIONS: The present study shows an advanced polyp miss rate that is comparable with other studies even in a fellowship training setting. Prospective studies with tandem surveillance colonoscopy are needed to confirm our findings.     

结肠镜检查不同时间行肠道准备质量比较

目的 比较结肠镜检查时不同时间行肠道准备的质量.方法 将2019-10～2020-01该院接受结肠镜检查的非麻醉门诊及住院患者130例,按随机数字表法分为观察组(64例)和对照组(66例).观察组于清晨5:00～7:00口服结肠清洁剂,上午完成结肠镜检查.对照组于上午10:00～12:00口服结肠清洁剂,下午完成结肠镜...     

Esophagogastroduodenoscopy-assisted bowel preparation for colonoscopy

AIM: To compare the quality and tolerance of esophagogastroduodenoscopy (EGD)-assisted and conventional split-dose polyethylene glycol electrolyte solution for inpatient colonoscopy.METHODS: The study was a randomized controlled trial in hospitalized patients. Hospitalized patients undergoing colonoscopy the day following EGD for evaluation of gastrointestinal (GI) bleeding or other symptoms. Patients randomized to either EGD-assisted bowel prep [2 L polyethylene glycol (PEG) administered endoscopically into distal duodenum at time of EGD, plus 1 L PEG orally the following day] or conventional-PEG (2 L PEG orally the evening prior and 1 L PEG orally the following day). The main outcome measurements are bowel preparation quality and patient tolerance of bowel prep.RESULTS: Forty-two patients randomized to EGD-assisted bowel prep and 40 patients to conventional-PEG. Overall mean ± SD preparation quality was superior for EGD-PEG (4.1 ± 2.8) vs conventional-PEG (6.5 ± 3.1; P = 0.0005). Seventy-four percent of patients rated EGD-PEG as easy or slightly difficult to tolerate compared to 46% for standard-PEG (P = 0.0133). Mean EGD-procedural time was greater for EGD-assisted subject (24 ± 10 min) compared to conventional-PEG prep subjects (15 ± 7 min; P < 0.0001). Conscious sedation requirements did not differ between groups. There were no significant prep-related adverse events in either group.CONCLUSION: In selected hospitalized patients, compared to a conventional split-dose regimen, use of EGD to administer the majority of PEG solution improves patient tolerance and quality of bowel preparation for colonoscopy.     

Evidence-based considerations on bowel preparation for colonoscopy

We recently read with interest the article, “Novel frontiers of agents for bowel cleansing for colonoscopy”. This is a practical narrative review, which could be of particular importance to clinicians in order to improve their current practice. Although we appreciate the venture of our colleagues, based on our in-depth analysis, we came across several minor issues in the article; hence, we present our comments in this letter. If the authors consider these comments further in their relevant research, we believe that their contribution would be of considerable importance for future studies.     

便秘患者行结肠镜检查前两种肠道准备方法的效果比较

目的探讨便秘患者结肠镜检查和治疗前更佳的肠道准备方法。方法观察组80例便秘患者先服用聚乙二醇4000散剂(福松),再予甘露醇+口服补液盐口服;对照组80例便秘患者仅服用甘露醇+口服补液盐。观察比较两组的肠道清洁度及有效率,并记录严重不良事件。结果观察组的清洁程度优于对照组(P<0.01),有效率也高于对照组(P<0.05),两组均无严重不良事件发生。结论便秘患者使用甘露醇+口服补液盐清肠前加用聚乙二醇4000散剂通便能提高肠道准备的有效率。     

莫沙必利联合二甲硅油散在慢性便秘患者结肠镜检查肠道准备中的应用

目的观察胃肠动力药莫沙必利联合二甲硅油散在慢性便秘患者行电子结肠镜检查前肠道准备过程中的应用效果。 方法选取徐州医科大学附属淮安医院拟行电子纤维结肠镜检查的慢性便秘患者300例,采用随机数字表法分为A组(复方聚乙二醇电解质散联合二甲硅油散)150例、B组(在A组的基础上联合莫沙必利口服)150例。采用Boston肠道量表进行肠道准备质量的评分、肠道气泡量表用于评估肠道内气泡的数量,并记录患者肠道准备时间,进镜时间及退镜时间、不良反应发生情况以及肠道疾病检出情况。 结果AB组2组实际完成肠镜检查过程分别为143例和146例,B组BBPS大于6分的比例明显高于A组(χ²＝5.141,P<0.05);B组肠道泡沫量评中I、Ⅱ级所占比例明显高于A组(χ²＝5.851,P<0.05)。且肠道准备所用时间、不良反应发生率及肠道病变检出率,B组也明显优于A组,差异有统计学意义(P<0.05)。 结论莫沙必利联合二甲硅油散作为肠道准备用药可以明显提高慢性便秘患者肠道清洁质量的同时显著减少肠腔内气泡的产生,也能减少肠道准备所用时间、降低不良反应发生率、提高肠道病变的检出率。     

Determination of large bowel length and loop complexity in patients with acromegaly undergoing screening colonoscopy

BACKGROUND: Patients with acromegaly are at moderately increased risk of developing colorectal cancer and may be considered for screening colonoscopy. In turn, large bowel dimensions may be increased in these patients, factors that predict for increased risk of serious complications such as perforation. OBJECTIVE: To evaluate this risk potential, we measured large bowel length and loop complexity using magnetic endoscopic imaging (MEI). DESIGN: Case-control study in 25 unselected patients with acromegaly (mean age 56 years) vs. 41 nonacromegalic controls (mean age 60 years) undergoing screening colonoscopy. MEASUREMENTS: MEI parameters were determined and age- and sex-adjusted mean differences calculated. The dependency of total large bowel length on various demographic and disease-related factors (e.g. GH exposure, IGF-I and IGFBP-3 concentrations) was assessed using regression techniques. RESULTS: Total large bowel length was increased by 20%[95% confidence interval (CI) 9-31%] in patients with acromegaly compared with controls (unadjusted and adjusted; P-values < 0.001). Acromegaly was also associated with increased time taken to reach the caecum (P = 0.01) and increased pelvic loop complexities (5/25 vs. 1/41, Fisher's exact test: P = 0.03). Total large bowel length was predicted by age at colonoscopy (P = 0.003) and patient height (P = 0.03), but not by surrogate biochemical markers of disease activity. CONCLUSIONS: Acromegaly is associated with increased large bowel length and loop complexity making colonoscopy technically challenging, and theoretically increasing the risk of serious complications. Patients need to be counselled accordingly, and appropriate resources with experienced staff allocated.     

Achieving the best bowel preparation for colonoscopy

Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here.