Factors affecting bowel preparation adequacy and procedural time

Abstract

Background and Aim Poor bowel preparation results in difficult colonoscopies, missed lesions, and repeat procedures. Identifying patient risk factors for poor bowel preparation, such as prolonged runway time and prolonged cecal intubation, will aid in interventions prior to a procedure. Methods This was a retrospective, single‐center analysis of 3 295 colonoscopies performed between May 2012 and November 2014. Indications for colonoscopy included gastrointestinal bleed and anemia, change in bowel habits, for screening, and others (including planning re‐anastomoses, abdominal distension, family history and angioectasias). Data were collected from medical charts and endoscopy reports. Comparisons between patient factors and runway time were made with adequacy of bowel preparation as the primary outcomes. Results Male and diabetic patients had statistically higher rates of inadequate bowel preparation and prolonged cecal intubation times. A previous history of abdominal surgery also demonstrated prolonged cecal intubation. A runway time of ≤7.63 h was associated with higher rates of adequate bowel preparation by multivariate analysis. The optimal time frame is 3–6 h for the highest success rates. Conclusion Patient risk factors for inadequate bowel preparation or prolonged cecal intubation should signal clinicians to intervene prior to colonoscopy. A runway time between 3 and 6 h is optimal for adequate bowel preparation. This may involve further patient education, along with work flow optimization, to facilitate ideal runway times. Future studies should explore how to avoid repeat endoscopies using protocols enforcing this timeframe.

Multi-step validation of a deep learning-based system for the quantification of bowel preparation: a prospective, observational study

“…In addition, recording of bowel preparation assess ments and recommending colonoscopy repetition at an earlier stage were frequently missing in 5-20% of colonoscopy reports and caused 10•3% of postcolonoscopy colorectal cancer. [9][10][11] Although more than 11•45 million colonoscopies are done in China annually, it is vital to develop an automatic bowel preparation recording system. 12 In clinical practice, inaccurate and missing bowel preparation recording could be attributed to multiple factors such as work load, shortage of supervision, and lacking practical tools.…”

The unmet needs for identifying the ideal bowel preparation

“…Another critical issue is the interval between consumption of the last dose of preparation solution and the beginning of colonoscopy (“runway time”), as outlined by a recent study conducted in 3205 patients 47 . An inverse correlation was consistently found between mucosal cleanliness and runway time; the optimal time for the last dose is 3 h before colonoscopy as recommended by the ESGE guidelines 15 .…”

Preparation for endoscopic examinations in patients with diabetes and hypoglycaemia

“…Some patients who fail colonoscopy due to insufficient bowel cleansing are indicated for a repeat procedure [ 2 , 6 ]. Repeat colonoscopy has consequences for the health care system – increasing costs and reducing access to the procedure, as well as for the patient – decreasing the quality of life due to the need to repeat preparation, which is considered unpleasant, and the examination itself, which is burdensome due to its invasiveness [ 2 ].…”

“…Repeat colonoscopy has consequences for the health care system – increasing costs and reducing access to the procedure, as well as for the patient – decreasing the quality of life due to the need to repeat preparation, which is considered unpleasant, and the examination itself, which is burdensome due to its invasiveness [ 2 ]. Improper bowel cleansing extends the duration of the entire procedure and is associated with an increased risk of adverse events [ 6 , 7 ]. Moreover, the necessity to repeat the examination reduces its availability, thus extending the waiting time for other patients [ 2 ].…”

“…Moreover, the necessity to repeat the examination reduces its availability, thus extending the waiting time for other patients [ 2 ]. An analysis carried out in the United States showed that colonoscopies are not cost-effective if the percentage of inadequately prepared patients exceeds 13% [ 6 ]. It was shown that at least one adenoma was detected in 33.8% of colonoscopies repeated due to inadequate bowel preparation [ 6 ].…”