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Zhao X, Pan Y, Hao J, Feng J, Cui Z, Ma H, Huang X. Development and validation of a novel scoring system based on a nomogram for predicting inadequate bowel preparation. Clin Transl Oncol 2024; 26:2262-2273. [PMID: 38565812 DOI: 10.1007/s12094-024-03443-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND AIMS Adequate bowel preparation (BP) is crucial for the diagnosis of colorectal diseases. Identifying patients at risk of inadequate BP allows for targeted interventions and improved outcomes. We aimed to develop a model for predicting inadequate BP based on preparation-related factors. METHODS Adult outpatients scheduled for colonoscopy between May 2022 and October 2022 were enrolled. One set (N = 913) was used to develop and internally validate the predictive model. The primary predictive model was displayed as a nomogram and then modified into a novel scoring system, which was externally validated in an independent set (N = 177). Inadequate BP was defined as a Boston Bowel Preparedness Scale (BBPS) score of less than 2 for any colonic segment. The model was evaluated by the receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA). RESULTS Independent factors included in the prediction model were stool frequency ≤ 5 (15 points), preparation-to-colonoscopy interval ≥ 5 h (15 points), incomplete dosage (100 points), non-split dose (90 points), unrestricted diet (88 points), no additional water intake (15 points), and last stool appearance as an opaque liquid (0-80 points). The training set exhibited the following performance metrics for identifying BP failure: area under the curve (AUC) of 0.818, accuracy (ACC) of 0.818, positive likelihood ratio (PLR) of 2.397, negative likelihood ratio (NLR) of 0.162, positive predictive value (PPV) of 0.850, and negative predictive value (NPV) of 0.723. In the internal validation set, these metrics were 0.747, 0.776, 2.099, 0.278, 0.866, and 0.538, respectively. The external validation set showed values of 0.728, 0.757, 2.10, 0.247, 0.782, and 0.704, respectively, indicating strong discriminative ability. Calibration curves demonstrated close agreement, and DCA indicated superior clinical benefits at a threshold probability of 0.73 in the training cohort and 0.75 in the validation cohort for this model. CONCLUSIONS This novel scoring system was developed from a prospective study and externally validated in an independent set based on 7 easily accessible variables, demonstrating robust performance in predicting inadequate BP.
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Affiliation(s)
- Xiaxia Zhao
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China.
| | - Yanglin Pan
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 Changle West Road, Xi'an, 710032, Shanxi, China
| | - Jinyong Hao
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Jie Feng
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zhongyuan Cui
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Huimin Ma
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Xiaojun Huang
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China
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Chen L, Kang X, Ren G, Luo H, Zhang L, Wang L, Zhao J, Zhang R, Zhang X, Zhao L, Pan Y. Individualized intervention based on a preparation-related prediction model improves adequacy of bowel preparation: A prospective, multi-center, randomized, controlled study. Dig Liver Dis 2024; 56:436-443. [PMID: 37735023 DOI: 10.1016/j.dld.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
AIMS An easy-to-use preparation-related model (PRM) predicting inadequate bowel preparation (BP) was developed and proved superior to traditional models in our previous study. Here we aimed to investigate whether PRM-based individualized intervention can improve BP adequacy. METHODS Patients undergoing morning colonoscopy were prospectively enrolled in 5 endoscopic centers in China. After standard BP of split-dose polyethylene glycol (PEG) was completed, patients were randomized (1:1) to the individualized group or standard group. High-risk patients predicted by PRM score ≥3 were instructed to drink an additional 1.5 L PEG in the individualized group while not in standard group. The primary endpoint was the rate of adequate BP, defined by segmental Boston bowel preparation scale ≥2. Secondary outcomes included adenoma detection rate (ADR) and adverse events. RESULTS 900 patients were randomly allocated to the individualized group (n = 449) and the control (n = 451). Baseline characteristics were similar between the two groups. The rates of high-risk patients were 19.6 % in individualized group and 19.7 % in standard group. In intention-to-treat analysis, adequate BP was 91.8 % in individualized group and 84.7 % in the standard group (p = 0.001). Among high-risk patients, adequate BP rate was 94.3 % in individualized group and 49.3 % in standard group (p < 0.001), and ADR were 40.9 % vs 16.9 %, respectively (p < 0.001). No significant differences were found regarding the adverse events and willingness to repeat BP (all p >0.05). CONCLUSIONS The individualized intervention using an additional dose of PEG to high-risk patients predicted by PRM, significantly improved BP quality. The intervention significantly improved ADR in high-risk patients. (ClinicalTrials.gov number: NCT04434625).
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Affiliation(s)
- Long Chen
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaoyu Kang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Gui Ren
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hui Luo
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Linhui Zhang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Limei Wang
- Department of Gastroenterology, Shaanxi Second People's Hospital, Xi'an, Shaanxi, China
| | - Jianghai Zhao
- Department of Gastroenterology, Huaihe Hospital of Henan University, Kaifeng, Henan, China
| | - Rongchun Zhang
- Department of Gastroenterology, Hongai Hospital, Xiamen, Fujian, China
| | - Xiaoying Zhang
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
| | - Lina Zhao
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China; Department of Radiotherapy, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
| | - Yanglin Pan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China.
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Vassallo R, Maida M, Zullo A, Venezia L, Montalbano L, Mitri RD, Peralta M, Virgilio C, Pallio S, Pluchino D, D'amore F, Santagati A, Sinagra E, Graceffa P, Nicosia G, Camilleri S, Gibiliaro G, Abdelhadi Y, Rancatore G, Scalisi G, Melita G, Magnano A, Conoscenti G, Facciorusso A. Efficacy of 1 L polyethylene glycol plus ascorbate versus 4 L polyethylene glycol in split-dose for colonoscopy cleansing in out and inpatient: A multicentre, randomized trial (OVER 2019). Dig Liver Dis 2024; 56:495-501. [PMID: 37574430 DOI: 10.1016/j.dld.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/24/2023] [Accepted: 07/30/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND AND AIMS Adequate bowel cleansing is essential for colonoscopy quality. A novel 1 L polyethylene glycol plus ascorbate (1 L PEG+ASC) solution has been recently introduced. Nevertheless, the efficacy of 1 L PEG+ASC as compared to that of high-volume bowel preparation in both inpatients and outpatients is still unclear. PATIENTS AND METHODS This single-blinded, non-inferiority study randomized patients undergoing colonoscopy to receive split-dose 1 L PEG+ASC or 4 L PEG. The primary endpoint was the overall cleansing success. Secondary endpoints were excellent cleansing and high-quality cleansing of the right colon, as well as lesions detection rate, patient compliance, tolerability and safety. RESULTS Overall, 478 patients were randomized to 1 L PEG+ASC (N = 236) or 4 L PEG (N = 242). The 1 L PEG+ASC showed higher cleansing success rate (91.8% vs 83.6%; P=0.01) and a high-quality cleansing of the right colon (52.3% and 38.5%; P=0.004) compared to 4 L PEG. Moreover, 1 L PEG+ASC achieved a higher cleansing success in out-patients (96.3%% vs 88.6%; P=0.018), and a similar success rate in the in-patients (84.7% vs 76.7%; P=0.18). Adenoma detection rate, tolerability and incidence of adverse events were comparable between preparations. CONCLUSIONS The 1 L PEG+ASC showed higher efficacy in achieving adequate colon cleansing compared with 4 L PEG, particularly in the right colon. No differences in the tolerability and safety were detected.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
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Zhang Y, Wang L, Wu W, Zhang S, Zhang M, She W, Cheng Q, Chen N, Fan P, Du Y, Song H, Hu X, Zhang J, Ding C. Predictors of inadequate bowel preparation in older patients undergoing colonoscopy: A systematic review and meta-analysis. Int J Nurs Stud 2024; 149:104631. [PMID: 37963423 DOI: 10.1016/j.ijnurstu.2023.104631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Factors that predict the quality of bowel preparation in older adults are unclear, and current guidelines do not provide specific recommendations. OBJECTIVE This meta-analysis aimed to identify risk factors for inadequate bowel preparation in older patients. METHODS PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases were searched from their inception to February 2023. Cohort and cross-sectional studies exploring the risk factors for inadequate bowel preparation were included in this systematic review. Odds ratio (OR) values from individual studies were pooled using fixed-effects and random-effects models. In addition, a sensitivity analysis and assessment of publication bias were performed. RESULTS This meta-analysis included six studies (n = 1553) on previous abdominal surgery, six studies (n = 1494) on constipation, seven studies (n = 1505) on diabetes, eight studies (n = 2093) on non-compliance with the diet regimen, seven studies (n = 1350) on incomplete intake of laxative, and nine studies (n = 2163) on inadequate exercise during preparation. The pooled analysis showed that history of abdominal surgery (OR = 2.72; 95 % confidence interval, CI: 2.07 to 3.56), constipation (OR = 3.56, 95 % CI: 2.41 to 5.25), diabetes (OR = 2.54, 95 % CI: 1.81 to 3.57), non-compliance with the diet regimen (OR = 2.51, 95 % CI: 1.96 to 3.21), incomplete intake of laxative (OR = 2.43, 95 % CI: 1.60 to 3.67), and inadequate exercise during preparation (OR = 3.13, 95 % CI: 2.39 to 4.11) were independent risk factors for inadequate bowel preparation in older patients undergoing colonoscopy. CONCLUSIONS Three comorbid factors and three behavioral factors were significantly associated with inadequate bowel preparation in older adults. This meta-analysis provides valuable information for developing predictive models of poor bowel preparation.
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Affiliation(s)
- Yuanyuan Zhang
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Lining Wang
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia
| | - Wenbi Wu
- School of Nursing, Dalian Medical University, Dalian 116044, Liaoning, China
| | - Shi Zhang
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Min Zhang
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Wenjing She
- Department of Nursing, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu, China
| | - Qianqian Cheng
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Nana Chen
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Pengxia Fan
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Yuxin Du
- School of Medical and Health Engineering, Changzhou University, Changzhou 213000, Jiangsu, China
| | - Haiyan Song
- Department of Nursing, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu, China
| | - Xianyu Hu
- Department of Cardiology, The First People's Hospital of Kunshan, Suzhou 215300, Jiangsu, China
| | - Jiajie Zhang
- Department of Nursing, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu, China
| | - Caiyan Ding
- Nursing Teaching and Research Department, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu, China.
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Yang W, Chen Y. Clinical application of intensified nursing intervention in electronic coloscopy preparation. Technol Health Care 2024; 32:2107-2113. [PMID: 38393933 DOI: 10.3233/thc-230774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND Electronic coloscopy is an invasive procedure and achieving an ideal result can be challenging, leading to low intestinal cleanliness scores and a poor intestinal polyp positive rate. OBJECTIVE (1) To demonstrate the impact of intensified nursing intervention on electronic colonoscopy. (2) To improve patients' satisfaction with medical services related to intestinal cleanliness during preparation, the accuracy of the intestinal polyp-positive rate, and nursing. METHODS Our study included 120 patients who underwent electronic coloscopy. These patients were randomly assigned to either the observation group or the control group, with 60 cases in each group. Patients in the control group received conventional nursing intervention, which included face-to-face oral and written instructions. In addition to the conventional intervention, patients in the observation group received intensified guidance interventions, which included instructions via phone, as well as WeChat messages and pictures. RESULTS The patients in the observation group who received intensified guidance interventions demonstrated better intestinal cleanliness during preparation compared to the control group (P< 0.05). Besides, the accuracy of the intestinal polyp positive rate was higher in the observation group than in the control group (P< 0.05). Finally, regarding patient satisfaction with the nursing service provided by the endoscopy center, the observation group had a higher level of satisfaction than the control group (P< 0.05). CONCLUSION The intensified guidance interventions provided to patients undergoing electronic colonoscopy resulted in a significant improvement in intestinal cleanliness during preparation, as well as an increase in the accuracy of the intestinal polyp-positive rate and patient satisfaction with our nursing service. Therefore, we believe that these interventions are highly beneficial and should be promoted and applied in clinical settings.
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Fostier R, Tziatzios G, Facciorusso A, Papaefthymiou A, Arvanitakis M, Triantafyllou K, Gkolfakis P. Models and scores to predict adequacy of bowel preparation before colonoscopy. Best Pract Res Clin Gastroenterol 2023; 67:101859. [PMID: 38103925 DOI: 10.1016/j.bpg.2023.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 12/19/2023]
Abstract
Adequate bowel preparation is of paramount importance for the effectiveness of preventive colonoscopy as it allows visualization of the mucosal surface and adenomas detection, the pre-malignant lesions leading to colon cancer. Still, a considerable portion of patients fail to achieve adequate bowel cleansing, with predictors of inadequate bowel preparation being at the focal point of several studies, so far. Incorporation of these factors within predictive models has been implemented in an effort to promptly identify patients at risk for inadequate bowel preparation and thus, timely adopt practices that have the potential to improve bowel cleansing. Ultimately, this could lead to improved procedural outcomes not only in terms of neoplastic detection rate but also interval repeat procedures, expenses, patient convenience and adverse events risk. Aim of this manuscript is to present an up to date overview of all predictive scores/models addressing bowel cleansing adequacy in everyday clinical practice.
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Affiliation(s)
- Romane Fostier
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Georgios Tziatzios
- Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio-Patision", Athens, Greece
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | | | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio-Patision", Athens, Greece.
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Zhao X, Yang L, Hu X, Kong G, Huang X. Enhancing bowel preparation quality and tolerability in a low health literacy population in Western China: a multicenter randomized trial. J Cancer Res Clin Oncol 2023; 149:17957-17971. [PMID: 37968520 DOI: 10.1007/s00432-023-05493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND AND AIMS Insufficient bowel preparation (BP) presents substantial challenges to the effectiveness of outpatient colonoscopy for colorectal cancer screening, particularly within populations characterized by low health literacy and poor adherence. METHODS We conducted a prospective, randomized, blinded, endoscopic controlled study involving 474 colonoscopy outpatients aged 18-80 years hailing from a low health literacy population with convenient access to WeChat. These patients were subsequently randomized into three groups: the control group, WeChat group, and the automatic reminder group (ARG). All people were administered 3 L of polyethylene glycol. The Boston Bowel Preparation Scale (BBPS) score of 6 or a segmental score of 2 was used as the primary outcome to evaluate BP quality. Secondary outcomes included polyp detection rate (PDR) and adverse events, etc. RESULTS: Our findings revealed that both the WeChat group (n = 158) and ARG (n = 158) exhibited significantly higher rates of adequate BP compared to the control group (n = 158) (WeChat vs. control, 79.1% vs. 61.4%; ARG vs. control, 74.7% vs. 61.4%; p < 0.001). Furthermore, these educationally reinforced groups displayed improved BP compliance (p < 0.05). According to the Hospital Anxiety and Depression Scale (HADS), patients in the reinforced education groups exhibited lower overall anxiety levels (p = 0.001) and experienced fewer adverse reactions (p = 0.019). Compared to the control group, the PDR in the right hemi-colon was significantly greater in the WeChat group (11.4%) (2.5%), and a similar trend was observed in the ARG (7.6%). Additionally, individuals in the WeChat group reported higher levels of satisfaction with their colonoscopy experience (p = 0.043). In a multivariate analysis, adjusting for potential confounding factors, WeChat-based re-education ([OR] 1.496, 95% CI 1.154-1.939; p = 0.002)) emerged as a protective factor for achieving adequate BP. CONCLUSION Enhanced education through WeChat can improve BP quality, and ARG applies equally to low health literacy populations.
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Affiliation(s)
- Xiaxia Zhao
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu Province, China
| | - Lihong Yang
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu Province, China
| | - Xiaoyu Hu
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu Province, China
| | - Guixiang Kong
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu Province, China
| | - Xiaojun Huang
- Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu Province, China.
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Higashimori A, Maeda N, Nakatani M, Yamamoto I, Yanagida T, Kin D, Matsumoto Y, Morimoto K, Sasaki E, Fukuda T, Arakawa T, Fujiwara Y. Importance of Bowel Habits in Predicting Inadequate Bowel Preparation: A Prospective Observational Study. Dig Dis Sci 2023; 68:4148-4155. [PMID: 37713038 DOI: 10.1007/s10620-023-08089-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/20/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES Inadequate bowel preparation (BP) negatively affects the efficacy and quality of colonoscopy. Although constipation has already been reported as one of the most important predictors of inadequate BP, there is limited information on the relation between inadequate BP and bowel habits including constipation-related symptoms, medications, and severity of constipation. METHODS This single-center, prospective observational study was conducted between August 2019 and May 2020. All participants answered questionnaires regarding personal bowel habits and received low-volume polyethylene glycol plus ascorbic acid for outpatient colonoscopy. Severity of constipation was evaluated by constipation scoring system. Bowel preparation cleansing was evaluated using Boston Bowel Preparation Scale (BBPS). Potential predictors of inadequate BP were analyzed using multivariate logistic regression models. RESULTS Overall, 1054 patients were enrolled, of which, 105 (10%) had inadequate BP (total BBPS ≤ 6 or any segmental BBPS < 2). The risk of inadequate BP increased with constipation severity (P = 0.01). Multivariate analysis showed that frequent straining (> 25% of defecations) (OR 2.09, 95% CI: 1.33-3.28) and chronic use of stimulant laxatives (OR 2.57, 95% CI: 1.59-4.17) were significant predictors of inadequate BP, among personal bowel habits. CONCLUSION Frequent straining and chronic use of stimulant laxatives were predictors of inadequate BP. An intensified preparation regimen should be considered for severely constipated patients with straining and chronic use of stimulant laxatives.
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Affiliation(s)
- Akira Higashimori
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan.
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan.
| | - Natsumi Maeda
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Masami Nakatani
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Ikki Yamamoto
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Takeshi Yanagida
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Daiyu Kin
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Yuji Matsumoto
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Kenichi Morimoto
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Eiji Sasaki
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Takashi Fukuda
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Tetsuo Arakawa
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
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Chen BR, Zhang LH, Shi ZH, Ding XW, Liu Y, Wang AX, Chen ZF, Yao LW, Gong RR, Wang JX, Wu LL, Liu J, Yu HG. Preoperative automatic reminder systems and impact on quality and compliance with colonoscopy preparation: A multicenter randomized controlled trial. J Dig Dis 2023; 24:530-539. [PMID: 37610349 DOI: 10.1111/1751-2980.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Traditional preoperative reminding services have been applied to enhance the quality of bowel preparation for colonoscopy. In this study we aimed to evaluate the effectiveness of an automated electronic reminder system (E-reminder) on improving bowel preparation and the quality of preoperative education before colonoscopy. METHODS From August 2021 to March 2022, 833 outpatients aged 50-75 years who underwent colonoscopy were included and randomly assigned to the E-reminder group and the control group. While the control group received routine preoperative education. The E-reminder group received automatic phone call, text message reminders and web services regarding the details of bowel preparation before the colonoscopic examination. The quality of bowel preparation was evaluated by the Boston Bowel Preparation Scale (BBPS) score and the previously validated objective evaluation scale of automatic BBPS (e-BBPS). RESULTS In manual assessment, the rate of adequate bowel preparation was improved in the E-reminder group of intention-to-treat population using BBPS (60.7% vs 54.5%, P = 0.01). The percentage of objective evaluated adequate bowel preparation using e-BBPS in the E-reminder group of per-protocol population was significantly higher than that in the control group (76.9% vs 69.2%, P = 0.02). CONCLUSIONS E-reminder was an effective tool to improve the quality of bowel preparation and compliance with medical instructions. It may be regarded as an efficient and convenient education tool, improving the quality of medical service.
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Affiliation(s)
- Bo Ru Chen
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Li Hui Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhao Hong Shi
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan, Hubei Province, China
| | - Xiang Wu Ding
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Yi Liu
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan, Hubei Province, China
| | - Ai Xiang Wang
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Zu Fang Chen
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Li Wen Yao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Rong Rong Gong
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jun Xiao Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Lian Lian Wu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jun Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Hong Gang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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10
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Shao YR, Zheng TH, Shan XZ, Li SS, Kang M. Visualization analysis of research on pre-colonoscopy bowel preparation. Shijie Huaren Xiaohua Zazhi 2023; 31:605-614. [DOI: 10.11569/wcjd.v31.i14.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Bowel preparation is an essential step before colonoscopy, and its research topics are relatively scattered. Understanding the research status and development trend of bowel preparation is of great value for disease research and actual clinical work. However, there is currently a lack of research in this field in the form of bibliometrics.
AIM To understand the research hotspots and development trends of bowel preparation during colonoscopy around the world.
METHODS The literature about the topics of bowel preparation was retrieved from the CNKI, Wanfang, VIP, China Biomedical Literature Database (CBM), and Web of Science core datasets from the inception of the database to September 10, 2022. CiteSpace 6.1. R3 was used to visually analyze the annual number of publications, countries, institutions, authors, keywords, clusters, and co-citation literature.
RESULTS A total of 2340 Chinese and 2574 English publications were included, and the number of annual publications showed an increasing trend from year to year. The author with the largest number of publications worldwide was Hassan Cesare, and the most productive countries included USA, Korea, UK, Italy, and China. Meng Xiao-Fen, Zhang Yuan-Yuan, and Niu Mei-E were the China's most prolific authors. The First Affiliated Hospital of Suzhou University, the General Hospital of the Chinese People's Liberation Army, and the Second Affiliated Hospital of Xi'an University were the most prolific institutions. Research hotspots focused on the quality of bowel preparation, the design of bowel preparation programs, and special groups for bowel preparation.
CONCLUSION Studies related to bowel preparation have certain foundations, and China's research can follow international hotspots, but cooperation among countries still needs to be strengthened. We should expand the research output related to bowel preparation based on a broader population and more suitable for the development of the era of big data, to provide higher quality research evidence for clinical practice.
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Affiliation(s)
- Yan-Ru Shao
- School of Nursing, Qingdao University, Qingdao 266000, Shandong Province, China
| | - Tao-Hua Zheng
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Xin-Zhi Shan
- Service Management Department, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Shan-Shan Li
- Neurosurgery Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Mei Kang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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11
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Xiong Z, Fang Y, Feng F, Cheng Y, Huo C, Huang J. 2L polyethylene glycol combined with castor oil versus 4L polyethylene glycol for bowel preparation before colonoscopy among inpatients. Medicine (Baltimore) 2023; 102:e34294. [PMID: 37478260 PMCID: PMC10662855 DOI: 10.1097/md.0000000000034294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/21/2023] [Indexed: 07/23/2023] Open
Abstract
Inpatients are more likely to have inadequate bowel preparation compared to outpatients. Although experts recommend 4L split polyethylene glycol (PEG) preparation, bowel preparation with castor oil (CaO) was recently found to reduce the volume of solution required. The aim of the study was to evaluate the cleansing effect and safety of 2L-PEG with Cao in bowel preparation among inpatients. Our study retrospectively analyzed the medical records and colonoscopy reports of inpatients (n = 1251) who underwent colonoscopy in the Affiliated Changzhou No.2 People Hospital of Nanjing Medical University, and the inpatients were divided into 2L-PEG-CaO and 4L-PEG group according to different bowel preparation protocols. Boston Bowel Preparation Scale (BBPS) is used to assess bowel preparation efficacy before colonoscopy. Furthermore, we also calculated other outcomes, such as polyp or adenoma detection rates and adverse events. A total of 1251 patients undergoing colonoscopy were included in this study, 738 were taken 4L-PEG and 513 2L-PEG-CaO. Both inpatients groups were matched for baseline characteristics. The 2L-PEG-CaO group was significantly higher than the 4L-PEG group on both BBPS (7.26 ± 1.75 vs 7.06 ± 1.58, P = .043) and adequate bowel cleansing rates (83.2% vs 77.4%, P = .011). Regarding adverse events, the 4L-PEG group was significantly higher than the 2L-PEG-CaO group on the incidence of abdominal fullness (6.4% vs 9.6%, P = .045) and adverse events (33.7% vs 28.5%, P = .048). The 2L split PEG with CaO preparation increased quality of bowel cleansing and improved tolerance in inpatients. Bowel preparation with 2L-PEG-CaO is suitable alternative to traditional 4L split PEG bowel preparation for colonoscopy of inpatients.
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Affiliation(s)
- Zhe Xiong
- Department of Gastroenterology, Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
- Department of Gastroenterology, Dalian Medical University, Dalian, Liaoning, China
| | - Ying Fang
- Department of Gastroenterology, Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
- Department of Gastroenterology, Dalian Medical University, Dalian, Liaoning, China
| | - Fangfang Feng
- Department of Gastroenterology, Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
- Department of Gastroenterology, Dalian Medical University, Dalian, Liaoning, China
| | - Yiming Cheng
- Department of Gastroenterology, Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
- Department of Gastroenterology, Dalian Medical University, Dalian, Liaoning, China
| | - Chunyan Huo
- Department of Gastroenterology, Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Jin Huang
- Department of Gastroenterology, Changzhou Second People’s Hospital of Nanjing Medical University, Changzhou, China
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12
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Kabir C, Salazar Leon M, Ndiaye C, Flicker M. Effect of acuity level and patient characteristics on bowel preparation quality: a retrospective cohort study of inpatient colonoscopies. BMC Gastroenterol 2023; 23:126. [PMID: 37061688 PMCID: PMC10105396 DOI: 10.1186/s12876-023-02751-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/28/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND AND AIMS Colonoscopy is the primary method to detect mucosal abnormalities in the colon, rectum, and terminal ileum. Inadequate bowel preparation is a common problem and can impede successful visualization during colonoscopy. Although studies identified hospitalization as a predictor of inadequate bowel preparation, acuity of care vary greatly within this patient population. The current study aims to examine the effect of patient characteristics and care level predictors on inadequate bowel preparation quality within the inpatient setting. METHODS This retrospective study was conducted in a single urban level 1 trauma medical center and included adult patients undergoing diagnostic colonoscopy while admitted in the hospital from January 1, 2015 to June 30, 2020. We examined the level of inpatient care between the General Medical Floor (GMF), Intensive Care Units (ICU) and Telemetry Unit (TU) and assessed this association with bowel preparation quality, adjusting for known and unknown predictors. RESULTS Of 538 patients undergoing colonoscopy, 47.4% were admitted into TU, 43.7% into GMF and 8.9% into ICU. For the entire sample, 72.7% of patients achieved good or excellent preparation and quality of bowel preparation differed by care level (P = 0.01). Patients from the critical care units were less likely to achieve adequate bowel preparation when compared to GMF (Odds Ratio [OR] 0.36; 95% Confidence Interval [CI] 0.17,0.77), after adjusting for patient characteristics, medications, physical status, and preparation regimen. No significant difference in Bowel Preparation Quality (BPQ) was identified between patients from GMF and TU (OR 0.96; 95%CI 0.61, 1.52). Furthermore, adequate BPQ was associated with withdrawal time and cecal intubation, but not higher adenoma detection rates. CONCLUSIONS Results suggest the ICU setting is an independent predictor for inadequate bowel preparation and patients with prior opioid and laxative use may be more likely to have inadequate bowel preparation in the hospital. Future interventions should prioritize preprocedural clinician meetings for critical care unit patients, including a more detailed readiness assessment and thorough medication history.
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Affiliation(s)
- Christopher Kabir
- Advocate Illinois Masonic Medical Center, Advocate Aurora Research Institute, Advocate Aurora Health, Center for Education, 836 W Wellington Ave, #2025, Chicago, IL 60657, USA.
| | - Mariani Salazar Leon
- Advocate Illinois Masonic Medical Center, Advocate Aurora Research Institute, Advocate Aurora Health, Center for Education, 836 W Wellington Ave, #2025, Chicago, IL 60657, USA
| | - Cindy Ndiaye
- Advocate Illinois Masonic Medical Center, Advocate Aurora Research Institute, Advocate Aurora Health, Center for Education, 836 W Wellington Ave, #2025, Chicago, IL 60657, USA
| | - Michael Flicker
- Advocate Illinois Masonic Medical Center, Advocate Aurora Research Institute, Advocate Aurora Health, Center for Education, 836 W Wellington Ave, #2025, Chicago, IL 60657, USA
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13
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Frazzoni L, La Marca M, DI Giorgio V, Laterza L, Bazzoli F, Hassan C, Fuccio L. Endoscopic surveillance after surgery for colorectal cancer. Minerva Med 2023; 114:224-236. [PMID: 32573518 DOI: 10.23736/s0026-4806.20.06732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Colorectal cancer (CRC) is one of the most common cancers worldwide and its global incidence is rapidly increasing among adults younger than 50 years, especially in the 20-39 age group. Once a curative resection is achieved, surveillance is mandatory. Colonoscopy has a pivotal role aimed at resecting premalignant neoplasms and detecting cancer at a curable stage. In the current review, an update on the role of surveillance colonoscopy after CRC is provided, considered the most recent international guidelines and evidence published on this issue. In particular, several questions have been answered, why, how and how often colonoscopy should be performed, whether intensive surveillance is more effective than standard surveillance, how endoscopically resected T1 cancer should be followed, the different management existing between colon and rectal cancer, and, finally, how to improve the endoscopic surveillance. In a period of resource constraints, appropriateness will be mandatory, thus understanding how to optimize the role of colonoscopy in the surveillance of patients with a history of CRC is of crucial importance. Improving the quality of colonoscopy and identifying risk factors for recurrent and new-onset CRC, will allow us to individualize the surveillance program while sparing health care cost.
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Affiliation(s)
- Leonardo Frazzoni
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Marina La Marca
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Valentina DI Giorgio
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Liboria Laterza
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Franco Bazzoli
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Cesare Hassan
- Unit of Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Lorenzo Fuccio
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy -
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14
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Shahini E, Sinagra E, Vitello A, Ranaldo R, Contaldo A, Facciorusso A, Maida M. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature. World J Gastroenterol 2023; 29:1685-1707. [PMID: 37077514 PMCID: PMC10107216 DOI: 10.3748/wjg.v29.i11.1685] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/02/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection. Nevertheless, almost a quarter of procedures are still carried out with suboptimal preparation, resulting in longer procedure times, higher risk of complications, and higher likelihood of missing lesions. Current guidelines recommend high-volume or low-volume polyethylene glycol (PEG)/non-PEG-based split-dose regimens. In patients who have had insufficient bowel cleansing, the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option. A strategy that includes a prolonged low-fiber diet, a split preparation regimen, and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly. Furthermore, even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients, clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients. Patients with severe renal insufficiency (creatinine clearance < 30 mL/min) should be prepared with isotonic high volume PEG solutions. Few data on cirrhotic patients are currently available, and no trials have been conducted in this population. An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation, especially in patients undergoing resection of left colon lesions, where intestinal preparation has a poor outcome. The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients, as well as strategies to improve colonoscopy preparation in these patients.
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Affiliation(s)
- Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Bari 70013, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Cefalù 90015, Italy
| | - Alessandro Vitello
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta 93100, Italy
| | - Rocco Ranaldo
- Department of Internal Medicine, “Mazzolani-Vandini” Hospital, Digestive Endoscopy, Ferrara 744011, Italy
| | - Antonella Contaldo
- Gastroenterology Unit, National Institute of Gastroenterology “S de Bellis” Research Hospital, Bari 70013, Italy
| | - Antonio Facciorusso
- Department of Medical Sciences, University of Foggia, Section of Gastroenterology, Foggia 71122, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta 93100, Italy
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15
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Iabichino G, Eusebi LH, Palamara MA, Luigiano C. Inpatients' bowel preparation: with teamwork we can win. Minerva Gastroenterol (Torino) 2023; 69:4-6. [PMID: 32623868 DOI: 10.23736/s2724-5985.20.02725-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
| | - Leonardo H Eusebi
- Department of Medical and Surgical Sciences, S. Orsola University Hospital, Bologna, Italy
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16
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Chen L, Ren G, Luo H, Zhang L, Wang L, Zhao J, Zhang R, Zhang X, Kang X, Pan Y. Superiority of a preparation-related model for predicting inadequate bowel preparation in patients undergoing colonoscopy: A multicenter prospective study. J Gastroenterol Hepatol 2022; 37:2297-2305. [PMID: 36181263 DOI: 10.1111/jgh.16010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/15/2022] [Accepted: 09/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Three models based on patient-related factors have been developed to predict inadequate bowel preparation (BP). However, the performance of the models seems suboptimal. This study aimed to develop a novel preparation-related model and compare it with the available patient-related models. METHODS Patients receiving standard BP were prospectively enrolled from five endoscopic centers. Patient-related and preparation-related factors for inadequate BP (defined by segmental Boston Bowel Preparation Scale score < 2) were identified by logistic regression. A preparation-related model was derived and internally validated in 906 patients. The comparisons of models were assessed by discrimination and calibration. The preparation-related model was also externally validated. RESULTS Several patient-related factors (male and American Society of Anesthesiologists Physical Status Classification System score ≥ 3) and preparation-related factors (drinking-to-stool interval ≥ 3 h, preparation-to-colonoscopy interval ≥ 6 h, and poor rectal effluent) were found to be independently associated with inadequate BP (all P < 0.05). C-statistics was 0.81 for the preparation-related model in the training cohort (n = 604), significantly higher than three available patient-based models (0.58-0.61). Similar results were observed in the validation cohort (n = 302). Calibration curves showed close agreement in the preparation-related model (R2 = 0.315 in the training cohort and 0.279 in the validation cohort). The preparation-related model was externally validated in another 606 patients with C-index of 0.80. CONCLUSIONS A new preparation-related model (consisting of drinking-to-stool interval ≥ 3 h, preparation-to-colonoscopy interval ≥ 6 h, and poor last rectal effluent) was developed and performed better than three available patient-related models. This easy-to-use model may be a useful decision-support tool on individualized plans in patients undergoing BP.
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Affiliation(s)
- Long Chen
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Gui Ren
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hui Luo
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Linhui Zhang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Limei Wang
- Department of Gastroenterology, Shaanxi Second People's Hospital, Xi'an, Shaanxi, China
| | - Jianghai Zhao
- Department of Gastroenterology, Huaihe Hospital of Henan University, Kaifeng, Henan, China
| | - Rongchun Zhang
- Department of Gastroenterology, Hongai Hospital, Xiamen, Fujian, China
| | - Xiaoying Zhang
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
| | - Xiaoyu Kang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yanglin Pan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
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17
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Luo L, Liu Y, Zhang L, Lai Y, Li Y, Liu K, Gong H, Jiang D, Wang E. Optimizing bowel preparation for colonoscopy: A cross-sectional study of the Chinese population. Front Public Health 2022; 10:953441. [PMID: 36033785 PMCID: PMC9412238 DOI: 10.3389/fpubh.2022.953441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/26/2022] [Indexed: 01/24/2023] Open
Abstract
Background The quality of bowel preparation is an important factor in the success of colonoscopy. However, the quality of bowel preparation is often affected by multiple factors. The main objective of this study was to explore the specific factors that affect the quality of bowel preparation. Methods Patients were consecutively recruited from the gastroenterology department in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology in Wuhan from May 2018 to December 2018. All patients were undergoing colonoscopy. Bowel preparation was evaluated by the Ottawa Bowel preparation Scale (OBPS) and all patients were categorized into 2 groups according to the OBPS. Multivariate analysis was conducted to identify the factors associated with bowel preparation quality. Results A total of 910 patients were included in the analysis with an average age of 48.62 ± 13.57 years. Patient source (P < 0.001) and the preparation method (P = 0.029) were correlated with OBPS adequacy. In addition, after stratified by age, preparation method (P = 0.022) was a significant factor among patients under 50 years old; whereas waiting time (P = 0.005) was a significant factor among patients over 50 years old. Conclusion Bowel preparation should be tailored based on the age of the patients to determine the most appropriate plan, including the most appropriate waiting time and the most appropriate purgative combination. Doctors should also focus more on the quality of bowel preparation in inpatients, who are more likely than outpatients to have an inadequate bowel preparation.
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Affiliation(s)
- Li Luo
- Department of Gastroenterology, West Hospital, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lingling Zhang
- Department of Gastroenterology, West Hospital, Union Hospital Affiliated to Tongji Medica, Wuhan, China
| | - Yihuan Lai
- DHC Mediway Technology Co., Ltd., Medical Big Data Research Institute, Beijing, China
| | - Yansheng Li
- DHC Mediway Technology Co., Ltd., Medical Big Data Research Institute, Beijing, China
| | - Kejia Liu
- DHC Mediway Technology Co., Ltd., Medical Big Data Research Institute, Beijing, China
| | - Houwu Gong
- DHC Mediway Technology Co., Ltd., Medical Big Data Research Institute, Beijing, China
| | - Dapeng Jiang
- DHC Mediway Technology Co., Ltd., Medical Big Data Research Institute, Beijing, China
| | - Erchuan Wang
- Department of Gastroenterology, West Hospital, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Erchuan Wang
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18
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Face-to-Face Instruction and Personalized Regimens Improve the Quality of Inpatient Bowel Preparation for Colonoscopy. Dig Dis Sci 2022; 67:3592-3600. [PMID: 34705157 DOI: 10.1007/s10620-021-07290-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/13/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Poor bowel preparation is commonly observed in inpatients undergoing colonoscopy, particularly those with higher risks for inadequate bowel preparation. AIMS The objective of this study was to determine whether personalized bowel preparation regimens combined with face-to-face instruction (FFI) could improve the quality of bowel preparation for inpatient. METHODS In this endoscopist-blinded, randomized controlled trial, 320 inpatients were enrolled and randomly allocated (1:1) to the control and intervention groups. The intervention group received FFI and personalized bowel preparation regimens, while the control group received the routine bowel preparation regimen and education. The primary outcome was adequate bowel preparation rate. Secondary outcomes included rates of procedure-related adverse events, incorrect diet restriction and laxative intake, etc. RESULTS: The adequate bowel preparation rate in the intervention group was significantly higher compared to control group [intention-to-treat (ITT) analysis: 70.0% vs 51.3%, P < 0.001; per-protocol (PP) analysis: 79.4% vs 58.6%, P < 0.001]. Bowel cleanliness was significantly improved in high-risk inpatients (ITT analysis: 65% vs 44.6%, P = 0.004; PP analysis: 73.0% vs 51.7%, P = 0.004) and in low-risk inpatients (ITT analysis: 80% vs 62.7%, P = 0.037; PP analysis: 92.3% vs 69.8%, P = 0.003). There were no significant differences between two groups regarding procedure-related adverse events. CONCLUSIONS Personalized bowel preparation regimens combined with FFI improve the rate of adequate bowel preparation, especially for patients with high-risk factors. As such, inpatients could benefit from this novel approach for better bowel preparation to ultimately improve the quality of colonoscopies.
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Sun CL, Li DK, Zenteno AC, Bravard MA, Carolan P, Daily B, Elamin S, Ha J, Moore A, Safavi K, Yun BJ, Dunn P, Levi R, Richter JM. Low-Volume Bowel Preparation Is Associated With Reduced Time to Colonoscopy in Hospitalized Patients: A Propensity-Matched Analysis. Clin Transl Gastroenterol 2022; 13:e00482. [PMID: 35347098 PMCID: PMC10476773 DOI: 10.14309/ctg.0000000000000482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/09/2022] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Delays in inpatient colonoscopy are commonly caused by inadequate bowel preparation and result in increased hospital length of stay (LOS) and healthcare costs. Low-volume bowel preparation (LV-BP; sodium sulfate, potassium sulfate, and magnesium sulfate ) has been shown to improve outpatient bowel preparation quality compared with standard high-volume bowel preparations (HV-BP; polyethylene glycol ). However, its efficacy in hospitalized patients has not been well-studied. We assessed the impact of LV-BP on time to colonoscopy, hospital LOS, and bowel preparation quality among inpatients. METHODS We performed a propensity score-matched analysis of adult inpatients undergoing colonoscopy who received either LV-BP or HV-BP before colonoscopy at a quaternary academic medical center. Multivariate regression models with feature selection were developed to assess the association between LV-BP and study outcomes. RESULTS Among 1,807 inpatients included in this study, 293 and 1,514 patients received LV-BP and HV-BP, respectively. Among the propensity score-matched population, LV-BP was associated with a shorter time to colonoscopy (β: -0.43 [95% confidence interval: -0.56 to -0.30]) while having similar odds of adequate preparation (odds ratio: 1.02 [95% confidence interval: 0.71-1.46]; P = 0.92). LV-BP was also significantly associated with decreased hospital LOS among older patients (age ≥ 75 years), patients with chronic kidney disease, and patients who were hospitalized with gastrointestinal bleeding. DISCUSSION LV-BP is associated with decreased time to colonoscopy in hospitalized patients. Older inpatients, inpatients with chronic kidney disease, and inpatients with gastrointestinal bleeding may particularly benefit from LV-BP. Prospective studies are needed to further establish the role of LV-BP for inpatient colonoscopies.
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Affiliation(s)
- Christopher L.F. Sun
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Darrick K. Li
- Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ana Cecilia Zenteno
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marjory A. Bravard
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter Carolan
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bethany Daily
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sami Elamin
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jasmine Ha
- Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amber Moore
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kyan Safavi
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
| | - Brian J. Yun
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter Dunn
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
| | - Retsef Levi
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - James M. Richter
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
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Yuan X, Gao H, Liu C, Wang W, Xie J, Zhang Z, Xu L. External validation of two prediction models for adequate bowel preparation in Asia: a prospective study. Int J Colorectal Dis 2022; 37:1223-1229. [PMID: 35467123 DOI: 10.1007/s00384-022-04156-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several models for predicting adequate bowel preparation are available but have never been externally validated. The aim of this study is to compare the available models in an independent population. METHODS This study prospectively recruited 500 consecutive patients from August to December 2020 from the Endoscopy Center of a tertiary hospital. All patients underwent the same bowel preparation regimen. The discrimination of the prediction models was quantified with the area under the receiver operating characteristic curve (AUC), and the 95% confidence interval (CI) was calculated for each AUC. RESULTS Finally, 461 patients were eligible for this study. A total of 110 (23.9%) patients were deemed to show inadequate bowel preparation during colonoscopy. There were significant differences between patients with and without adequate bowel preparation in terms of current hospitalization, procedure time, comorbidities (including diabetes and constipation), American Society of Anesthesiologists Physical Status Classification System score (ASA) ≥ 3, medication usage, and abdominal/pelvic surgery. The prediction models performed as follows: the Dik ≥ 2 model, the Dik ≥ 3 model, and the Antonio > 1.225 model had AUCs of 0.660 (95% CI = 0.604-0.717), 0.691 (95% CI = 0.646-0.733), and 0.645 (95% CI = 0.615-0.704), respectively. Comparison of the two prediction models showed no significant improvement (Antonio > 1.225 vs. Dik ≥ 3, 1.801, 95% CI = -0.004-0.096, P = 0.072). CONCLUSIONS Both models are potentially helpful. However, it is necessary to develop or improve a prediction model to obtain a more suitable and detailed model. TRIAL REGISTRATION ClinicalTrials.gov, Number NCT04607161.
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Affiliation(s)
- Xin Yuan
- School of Medicine, Ningbo University, Zhejiang, China
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Hui Gao
- School of Medicine, Ningbo University, Zhejiang, China
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Cenqin Liu
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
- College of Medicine, Zhejiang University, Zhejiang, China
| | - Weihong Wang
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Jiarong Xie
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Zhixin Zhang
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Lei Xu
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China.
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21
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Adamek HE, Bergmann L, Müssig K. [Bowel preparation in patients with Diabetes mellitus: Development of a procedure model]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:784-789. [PMID: 35545113 DOI: 10.1055/a-1791-1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adequate bowel preparation prior to colonoscopy is the key factor for high quality preparation for colonoscopy. Inadequate preparation can result in prolonged procedure time, incomplete colonoscopy and an increased risk of procedural adverse events. Diabetes mellitus has been identified as a predictor of inadequate colonoscopy bowel preparation. Currently, standard recommendations for diabetes patients before colonoscopy are missing. METHODS This review is based on a selective literature search in PubMed and Google Scholar carried out in June 2021. Systematic reviews, guidelines, expert opinions, and recommendations from German and international societies were also considered. RESULTS The currently available preparations comprise two different groups: High-, medium- and low- volume polyethylene glycol (PEG) preparations and hyperosmotic agents. So far, a couple of reviews tried to identify outcome related differencies. Results are heterogeneous. In practise, preparation agents and timing of preparation as well as a thorough patient information before the preparation process are considered the most relevant items. In diabetes patients, preinterventional dietary recommendations are of paramount importance. CONCLUSION Split dosing of PEG preparations are recommended in diabetes patients with expected motility disorders. Extensive counseling about preparation intake and dietary recommendations should be offered.
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Affiliation(s)
| | - Laura Bergmann
- Med. Klinik 2, Klinikum Leverkusen gGmbH, Leverkusen, Germany
| | - Karsten Müssig
- Klinik für Innere Medizin und Gastroenterologie, Niels-Stensen-Kliniken GmbH, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
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22
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Di Leo M, Iannone A, Arena M, Losurdo G, Palamara MA, Iabichino G, Consolo P, Rendina M, Luigiano C, Di Leo A. Novel frontiers of agents for bowel cleansing for colonoscopy. World J Gastroenterol 2021; 27:7748-7770. [PMID: 34963739 PMCID: PMC8661374 DOI: 10.3748/wjg.v27.i45.7748] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/23/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of colorectal cancer (CRC) is characterized by rapid declines in the wake of widespread screening. Colonoscopy is the gold standard for CRC screening, but its accuracy is related to high quality of bowel preparation (BP). In this review, we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy. Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’ acceptability. The role of the diet before colonoscopy was also changed, as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’ tolerance and/or quality of BP. The review also described BP in special situations, as lower gastrointestinal bleeding, elderly people, patients with chronic kidney disease, patients with inflammatory bowel disease, patients with congestive heart failure, inpatient, patient with previous bowel resection, pregnant/lactating patients. The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales. Finally, the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota. Moreover, the study underlined several points needed to further investigations.
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Affiliation(s)
- Milena Di Leo
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Monica Arena
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | | | | | - Pierluigi Consolo
- Unit of Digestive Endoscopy, University of Messina, Hospital "G. Martino", Messina 98121, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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Tontini GE, Prada A, Sferrazza S, Ciprandi G, Vecchi M. The unmet needs for identifying the ideal bowel preparation. JGH OPEN 2021; 5:1135-1141. [PMID: 34621998 PMCID: PMC8485412 DOI: 10.1002/jgh3.12653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/21/2021] [Indexed: 12/23/2022]
Abstract
Colonoscopy, since it was first employed over 60 years ago, is now the gold standard method for visualizing the mucosa of the colon, but should be of good quality. Many factors affect quality, including the type of health service organization, type of facility, staff, equipment, patient characteristics, and bowel preparation (BP). The adequacy of bowel cleansing is critical, but, unfortunately, may be inadequate in up to one‐third of procedures. The current article will present and discuss the main BPs and their drawbacks, which include patient‐dependent and procedure‐dependent factors. Cleansing quality depends on the ease/complexity of solution preparation, volume, taste, and timing of consumption. Consequently, important positive factors include simple instructions, easy preparation of the solution, low volume, pleasant taste, short drinking time (e.g. <30 min), and splitting the dose between the evening before and the morning of the colonoscopy (or even better, only one dose in the early morning to avoid night‐time problems), and short onset of action. The BP solution must also be safe with negligible side effects. Furthermore, a positive experience supports patient willingness to repeat the procedure.
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Affiliation(s)
- Gian E Tontini
- Department of Internal Medicine Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Alberto Prada
- Digestive Endoscopy Istituto Auxologico Italiano Milan Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Area Chirurgia Specialistica Santa Chiara Hospital Trento Italy
| | - Giorgio Ciprandi
- Outpatient Department, Casa di Cura Villa Montallegro Genoa Italy
| | - Maurizio Vecchi
- Department of Internal Medicine Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
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Benech N, Vinet O, Gaudin JL, Benamouzig R, Dray X, Ponchon T, Galmiche JP, Sacher-Huvelin S, Samaha E, Saurin JC. Colon capsule endoscopy in clinical practice: lessons from a national 5-year observational prospective cohort. Endosc Int Open 2021; 9:E1542-E1548. [PMID: 34540548 PMCID: PMC8445686 DOI: 10.1055/a-1526-0923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/25/2021] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Colon capsule endoscopy (CCE) has been proposed as an alternative to colonoscopy for screening patients at average risk of colorectal cancer (CRC). A prospective national cohort was developed to assess relevance of CCE in real-life practice and its short- and long-term impacts on clinical management. Patients and methods All patients who underwent a CCE in France were prospectively enrolled from January 2011 to May 2016 and reached annually by phone until May 2017. All CCE and colonoscopy reports were systematically collected. Results During the study period, 689 CCEs were analyzed from 14 medical centers. Median follow-up time was 35 months [IQR: 12-50]. Indication for CCE was mainly for elderly patients (median age: 70 years, IQR: [61-79]) due to anesthetic or colonoscopy contraindication (n = 307; 44.6 %). Only 337 CCEs (48.9 %) were both complete and with adequate bowel preparation. Advanced neoplasia (adenoma with high-grade dysplasia or CRC) was diagnosed following 32 CCEs (4.6 %). Among patients who underwent colonoscopy or therapeutic surgery following CCE, 18.8 % of all advanced neoplasias (6/32) had not been diagnosed by CCE mainly due to technical issues. Performing a colonoscopy in the case of significant polyps or insufficient bowel cleansing or after an incomplete CCE allowed the diagnosis of 96.9 % of all identified advanced neoplasias (31/32). Conclusions Outside the scope of academic trials, improvement is needed to increase the reliability of CCE as less than half were considered optimal i. e. complete with adequate bowel cleansing. Most of missed colonic advanced neoplasia were due to incomplete CCE with distal neoplasia location.
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Affiliation(s)
- Nicolas Benech
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Vinet
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Louis Gaudin
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Robert Benamouzig
- Service de Gastro-entérologie, Hôpital d’Avicenne, Assistance Publique- Hôpitaux de Paris, Bobigny, France
| | - Xavier Dray
- Centre d’Endoscopie digestive, Hôpital Saint-Antoine, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Thierry Ponchon
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | | | - Elia Samaha
- Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Jean-Christophe Saurin
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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de Sousa Magalhães R, Boal Carvalho P, Rosa B, Moreira MJ, Cotter J. The Prediction of Inadequate Colon Capsule Cleansing: A Cohort Selection Guided by CC-CLEAR. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 29:311-321. [PMID: 36159193 PMCID: PMC9485925 DOI: 10.1159/000518588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
Introduction In order to optimize the rate of adequate cleansing in colon capsule, it may be important to identify risk factors that can predict a suboptimal colon preparation. Aim To define predictive factors for inadequate bowel preparation in colon capsule, according to CC-CLEAR (Colon Capsule CLEansing Assessment and Report). Methods Retrospective, single center, cohort study. Patients' demographics, data, and quality of bowel preparation, according to CC-CLEAR, were collected retrospectively. A univariate analysis tested the association between covariables and the outcome, inadequate cleansing. The statistically significant variables were included in multivariable logistic binary regression, and a receiver operating characteristic curve (ROC) assessment was performed. Results We included 167 consecutive colon capsules. Sixty-eight percent (n = 114) of patients were female, with a mean age of 64 years. The main indication for colon capsule was previous incomplete colonoscopy, in 158 patients (94.6%). The colon capsules cleansing was graded as good or excellent in 96 patients (57.5%) and as inadequate in 71 (42.5%), according to CC-CLEAR. The variables inadequate previous colon cleansing (OR adjusted 41.72 [95% CI 12.57–138.57], p value < 0.001); chronic laxative (OR adjusted 4.86 [95% CI 1.08–21.79], p value = 0.039); antidepressant (OR adjusted 5.00 [95% CI 1.65–15.16], p value = 0.004), and impaired mobility (OR adjusted 5.54 [95% CI 1.17–26.31], p value = 0.031) were independently associated with the outcome inadequate cleansing, after adjusting for confoundment. The model presented an excellent discriminative power towards the outcome variable (AUC ROC 0.937 [CI 95% 0.899–0.975], p value < 0.001). Conclusion A previous inadequate colon cleansing, the use of chronic laxative and antidepressant, or impaired mobility are predictors of inadequate colon capsule cleansing, as assessed by the CC-CLEAR. These 4 predictors come together as a model enabling an accurate categorization of the patients at major risk of inadequate bowel preparation for capsule colonoscopy, with an excellent discriminative power and performance, which seems useful for the selection of patients for tailored optimization of the colon cleansing protocol.
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Affiliation(s)
- Rui de Sousa Magalhães
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
- * Rui de Sousa Magalhães,
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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Sinagra E, Sferrazza S, Vitello A, Morreale G, Rossi F, Conoscenti G, Pallio S, Raimondo D, Maida M. Effectiveness and Tolerability of Very-low Volume Preparation for Colonoscopy: A Narrative Review. Curr Drug Metab 2021; 22:85-88. [PMID: 33292108 DOI: 10.2174/1389200221999201208212007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022]
Abstract
An adequate bowel preparation is essential for a successful colonoscopy, in particular, in the setting of colorectal cancer screening. However, up to one-quarter of colonoscopies are associated with inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, prolonged procedural time, and an increased likelihood of repeat the procedure. The ideal intestinal preparation should provide an optimal observation of the mucosa (at least > 90% of the visible surface), with adequate acceptability and safety for the patient. With this premise, a very low-volume 1 L PEG-ASC solution (Plenvu; Norgine, Harefield, United Kingdom) has been recently introduced to improve patients' experience in colonoscopy by reducing the total intake of liquids to be consumed. This could represent a valid option for bowel cleansing, considering CRC screening and surveillance programs, improving both the quality of the examination and the patients' compliance. Nevertheless, it must be emphasized that a "one size fits all" preparation strategy is not feasible and that a bowel preparation regime must always be selected and tailored by the clinician for each patient, evaluating the best options on a case by case basis. This narrative review aims to sum up the evidence regarding new bowel preparation regimens in order to help clinicians to tailor the best choice for patients undergoing colonoscopy.
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Affiliation(s)
- Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Istituto San Raffaele Giglio, Cefalu, Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento, Italy
| | - Alessandro Vitello
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy
| | - Gaetano Morreale
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy
| | - Francesca Rossi
- Gastroenterology and Endoscopy Unit, Istituto San Raffaele Giglio, Cefalu, Italy
| | - Giuseppe Conoscenti
- Gastroenterology and Endoscopy Unit, Istituto San Raffaele Giglio, Cefalu, Italy
| | - Socrate Pallio
- Digestive Diseases Endoscopy Unit, Policlinico G. Martino Hospital, University of Messina, Messina, Italy
| | - Dario Raimondo
- Gastroenterology and Endoscopy Unit, Istituto San Raffaele Giglio, Cefalu, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy
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Frazzoni L. Patient education for colonoscopy in the time of computers: are you ready, player one? Endoscopy 2021; 53:264-265. [PMID: 33631825 DOI: 10.1055/a-1261-9632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Leonardo Frazzoni
- Gastroenterology Unit, Department of Medical and Surgical Sciences, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
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Triantafyllou K, Gkolfakis P, Skamnelos A, Diamantopoulou G, Dagas A, Tziatzios G, Thomopoulos K, Potamianos S, Christodoulou D. Impact of simple, specific, verbal instructions on the quality of bowel preparation in hospitalized patients undergoing colonoscopy: a multicenter randomized controlled trial. Endosc Int Open 2021; 9:E378-E387. [PMID: 33655037 PMCID: PMC7895659 DOI: 10.1055/a-1339-0913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022] Open
Abstract
Background and study aims Bowel preparation for colonoscopy is frequently inadequate in hospitalized patients. We explored the impact of specific verbal instructions on the quality of inpatients bowel preparation and factors associated with preparation failure. Patients and methods Randomized (1:1), two strata (mobilized vs. bedridden; 3:2) trial of consecutive inpatients from four tertiary centers, who received either specific, verbal instructions or the standard of care (SOC) ward instructions about bowel preparation. The rate of adequate bowel preparation (Boston Bowel Preparation Score [BBPS] ≥ 6, no segment < 2) comprised the primary endpoint. Mean BBPS score, good (BBPS score ≥ 7, no segment score < 2) and excellent (BBPS = 9) were among secondary endpoints. Results We randomized 300 inpatients (180 mobile) aged 71.7 ± 15.1 years in the intervention (49.7 %) and SOC (50.3 %) groups, respectively. Overall, more patients in the intervention group achieved adequate bowel preparation, but this difference did not reach statistical significance neither in the intention-to-treat [90/149 (60.4 %) vs. 82/151 (54.3 %); P = 0.29] nor in the per-protocol analysis [90/129 (69.8 %) vs. 82/132 (62.1 %); P = 0.19]. Overall BBPS score did not differ statistical significantly in the two groups, but the provision of specific verbal instructions was associated with significant higher rates of good (58.1 % vs. 43.2 %; P = 0.02) and excellent (31.8 % vs. 16.7 %; P = 0.004) bowel preparation compared to the SOC group. Administration of same-day bowel preparation and patient American Society of Anesthesiologists score > 2 were identified as risk factors for inadequate bowel preparation. Conclusions Provision of specific verbal instructions did not increase the rate of adequate bowel preparation in a population of mobilized and bedridden hospitalized patients.
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Affiliation(s)
- Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens
| | - Alexandros Skamnelos
- Division of Gastroenterology, University Hospital & Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgia Diamantopoulou
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Athanasios Dagas
- Department of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens
| | - Konstantinos Thomopoulos
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Spyros Potamianos
- Department of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Dimitrios Christodoulou
- Division of Gastroenterology, University Hospital & Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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de Miranda Neto AA, de Moura DTH, Hathorn KE, Tustumi F, de Moura EGH, Ribeiro IB. Efficacy and Patient Tolerability of Split-Dose Sodium Picosulfate/Magnesium Citrate (SPMC) Oral Solution Compared to the Polyethylene Glycol (PEG) Solution for Bowel Preparation in Outpatient Colonoscopy: An Evidence-Based Review. Clin Exp Gastroenterol 2020; 13:449-457. [PMID: 33116741 PMCID: PMC7548852 DOI: 10.2147/ceg.s237649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022] Open
Abstract
Background Colonoscopy is the gold standard exam for evaluation of colonic abnormalities and for screening and surveillance for colorectal cancer. However, the efficacy of colonoscopy is dependent on the quality of the pre-colonoscopy bowel preparation. Polyethylene glycol (PEG) and sodium picosulfate/magnesium citrate (SPMC) have emerged as two of the most commonly used bowel preparation agents. We conducted an evidence-based review of current evidence to further investigate the efficacy and patient tolerability of split-dose SPMC oral solution compared to PEG solution for colonoscopy bowel preparation. Methods A systematic search was performed using Pubmed (MEDLINE), Web of Science, EMBASE, and Cochran Central Register of Controlled Trials databases. All studies on split-dose bowel preparation with SPMC and PEG were reviewed. Relevant studies regarding colonoscopy and bowel preparations were also included. Randomized controlled trials were prioritized due to the high quality of evidence. Results Eight randomized controlled trials were included. Split-dose SPMC and PEG were associated with similar results for adequacy of bowel preparation. Split-dose SPMC was associated with increased patient tolerability and compliance. Conclusion Split-dose SPMC and PEG are both adequate and safe for bowel preparation for outpatient colonoscopy, with split-dose SPMC being more tolerable for patients. Additional RCTs comparing these and other bowel preparation solutions are necessary to further investigate quality of bowel preparation, patient preference, and cost-effectiveness of the various options.
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Affiliation(s)
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Hospital Das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.,Division of Gasteoenterology, Hepatology and Endoscopy - Brigham and Women´s Hospital - Harvard Medical School, Boston, MA, USA
| | - Kelly E Hathorn
- Division of Gasteoenterology, Hepatology and Endoscopy - Brigham and Women´s Hospital - Harvard Medical School, Boston, MA, USA
| | - Francisco Tustumi
- Gastrointestinal Surgery Unit, Hospital Das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital Das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
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