Lifestyle Factors and Bowel Preparation for Screening Colonoscopy

Factors Affecting the Quality of Bowel Preparation Before Colonoscopy in Outpatient: A Prospective Observational Study

Colonoscopy is an effective method for screening colorectal cancer and adenoma, but the adenoma detection rate depends on the quality of bowel preparation. Our study investigates the influencing factors of the quality of bowel preparation before colonoscopy in outpatients and the influence of the number of walking steps on the quality of bowel preparation. We prospectively collected the clinical data of 150 outpatients undergoing colonoscopy in our department in 2019. Ordinal logistic regression shows that the overweight, not drinking, the number of walking steps before colonoscopy, and the time interval between start PEG and colonoscopy (4-6 hours) were independent factors affecting bowel preparation quality. There was a curving relationship between the reciprocal of Ottawa score and the number of walking steps before colonoscopy, and the regression equation is 1/ Ottawa score = -0.198 + 0.062 × ln steps (p = .035), a minimum of 5,270 walking steps before a colonoscopy is required for a high quality of bowel preparation.

Efficacy and tolerability of colonoscopies in overweight and obese patients: Results from a national database on gastrointestinal endoscopic outcomes

Background and study aims  Gastroenterologists are encountering a rising number of obese patients requiring colonoscopy. Existing literature regarding colonoscopy outcomes in this population is scant and conflicting. We analyzed a nationwide cohort of patients to identify the effects of body mass index (BMI) on colonoscopy success, efficacy, and tolerability. Patients and methods  The Clinical Outcomes Research Initiative (CORI) endoscopic database was queried for all colonoscopies in adults between 2008-2014. Patients were stratified into four cohorts based on BMI classification for comparison. Multivariable analysis was performed to identify the effect of BMI on procedure outcome, efficacy and tolerability. Results  Of 41,401 procedures, 27,696 met study inclusion criteria. Of these, 49.4 % were performed for colorectal cancer screening, most commonly under anesthesia directed sedation. Patient discomfort was the reason for an incomplete colonoscopy in 18.7 % of all cases, and more frequent among the overweight and obese cohorts. An inadequate bowel preparation was most common in the class III obesity cohort. Compared to the normal BMI group, a BMI ≥ 30 and < 40 kg/m ² was associated with an increased odds of an incomplete colonoscopy ( P  = 0.001for overweight, P  = 0.0004 for class I/II obesity), longer procedure ( P  < 0.05 for all) and poorer tolerance ( P  < 0.0001 for class I/II obesity, P  = 0.016 for class III obesity). Anesthesia-administered sedation was more commonly used than endoscopist directed sedation amongst the obese cohort compared with the normal BMI cohort ( P  < 0.0001). Conclusions  Endoscopists should consider the increased odds of incomplete colonoscopy, longer procedures, and poorer tolerance when performing colonoscopy in obese patients to improve clinical management and procedural outcome.

Risk Factors for Suboptimal Bowel Preparation for Colonoscopy in Pediatric Patients

BACKGROUND/AIMS

Suboptimal bowel cleansing is common in children and can impact diagnostic and therapeutic outcomes. We aimed to identify risk factors for suboptimal bowel preparation for colonoscopy in pediatric patients.

METHODS

This was a retrospective study of all patients ages 0 to 21 years who underwent colonoscopy at a children's hospital from 2015 to 2019 in the United States. Demographics and clinical information were obtained from the electronic health record. The primary outcome was suboptimal bowel preparation measured by the endoscopist on a dichotomized Aronchik Scale. Univariate and multivariate regression modeling were used to determine independent predictors of suboptimal preparation.

RESULTS

Nine hundred and eight patients (mean age 12.17 years [±5.14], boys 465 (51.2%), were included in the analysis. Suboptimal preparation was noted in 242 (26.7%). On univariate analysis, suboptimal preparation was more common in those of younger age (38.6%), Medicaid (32.1%), Spanish as primary language (35.7%), and failure to thrive (FTT) (45.9%). Suboptimal preparations were less common in patients with inflammatory bowel disease (IBD) (11.6%). After adjustment for other covariates, IBD and FTT maintained their statistical associations, IBD (odds ratio [OR] 0.27 95% confidence interval [CI] 0.095-0.75, P =  0.01), FTT (OR 1.98 95% CI 1.28-3.06, P =  <0.01).

CONCLUSIONS

To our knowledge, this is the first investigation of pediatric patients to identify independent risk factors for suboptimal bowel preparation. We confirm Medicaid status and English as a second language as risk factors as well as highlight distinct associations from those reported in the adult literature including FTT and younger age. IBD was associated with optimal cleansing. Future research to understand the mechanisms of inferred risk or potential protection is required.

Risk Factors of Inadequate Bowel Preparation for Screening Colonoscopy

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

Novel sulfate tablet PBK-1701TC versus oral sulfate solution for colon cleansing: A randomized phase 3 trial

BACKGROUND AND AIM

PBK-1701TC is a novel sulfate tablet-based that contains 320 mg of simethicone and delivers 90% of the salt and water delivered by oral sulfate solution (OSS) preparation. This study evaluated the efficacy, safety, and tolerability of PBK-1701TC compared with OSS in bowel preparation for colonoscopy.

METHODS

This randomized, multicenter, phase 3 non-inferiority trial included adults aged 19 years or older with a body mass index of 19-30 kg/m² undergoing colonoscopy at five university hospitals in Korea. The primary efficacy endpoint was successful bowel-cleansing rate, defined as Harefield Cleansing Scale grade A or B as evaluated by blinded central readers. Secondary endpoints included the presence of residual air bubbles. Adverse events and laboratory evaluations were monitored to assess safety. Tolerability was assessed via participant interview.

RESULTS

Overall, 235 participants were randomized, and 224 were included in the per-protocol analysis (PBK, 112; OSS, 112). Successful bowel cleansing was achieved for 95.5% (107/112) in the PBK group, which was non-inferior to the OSS group (98.2%, 110/112) with a difference of -2.7% (one sided 97.5% confidence limit, -8.1%). The participants in the PBK group had fewer intraluminal bubbles (0.9% vs 81.3%, P < 0.001) and reported a lower incidence of nausea and vomiting, with better acceptance, taste, and willingness to repeat the regimen than those in the OSS group (all P < 0.05).

CONCLUSION

The novel sulfate tablet, PBK-1701TC, was non-inferior to OSS with respect to bowel-cleansing efficacy and exhibited better safety and tolerability in adults undergoing colonoscopy.

A Randomized Trial of Split Dose 3 L Polyethylene Glycol Lavage Solution, 2 L Polyethylene Glycol Lavage Combined With Castor Oil, and 1 L of Polyethylene Glycol Lavage Solution Combined With Castor Oil and Ascorbic Acid for Preparation for Colonoscopy

Background: Castor oil (CaO) has the potential of halving the required volume of bowel preparation solution; however, no clinical trial investigated the efficacy of CaO on bowel preparation for colonoscopy in addition to polyethylene glycol (PEG).

Objectives: Our aim was to evaluate efficacy and safety of lower dose PEG together with 30 mL CaO alone or plus ascorbic acid (Asc) in bowel preparation before colonoscopy.

Methods: Two hundred and forty-six patients were allocated randomly to ingest 2 L PEG with 30 mL CaO, 1 L PEG with 30 mL CaO plus 5 g Asc, or 3 L PEG. We used Boston Bowel Preparation Scale (BBPS) to evaluate bowel preparation efficacy. We also determined other outcomes such as procedure time, polyp or adenoma detection rate, and adverse events (AEs).

Results: Of 282 patients recruited, 36 were excluded. Groups were matched for baseline characteristics except weight (P = 0.020) and body mass index (BMI) (P = 0.003). Patient's satisfaction was higher in 2 L PEG-CaO (P = 0.016) and 1 L PEG-CaO-Asc groups (P = 0·017). Patients' compliance was 67.5, 71.4, and 80.5% in 3 L PEG, 2 L PEG-CaO, and 1 L PEG-CaO-Asc groups (P = 0.014). Adequate bowel preparation rate was 75, 78.57, and 53.66% in 3 L PEG, 2 L PEG-CaO, and 1 L PEG-CaO-Asc groups (P = 0.021). There were no differences in terms of remaining outcomes.

Conclusions: Despite an increase in patients' satisfaction and compliance, 1 L PEG-CaO-Asc significantly decreased adequate bowel preparation rate. However, 2 L PEG-CaO improved the patients' satisfaction and compliance and increased adequate bowel preparation rate (Registration number, ChiCTR-IIR-17012418).