Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature

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.

The Yield of Colonoscopy in the Evaluation of Constipation: An Age-Based Analysis of Outcome

“…Our study revealed several critical findings, the first of which is the substantial difference in bowel preparation quality between constipated patients and controls. In accordance with previous studies [16,17], we observed that constipated patients, including younger patients with constipation, exhibited a lower rate of adequate bowel preparation (92.7% vs. 85.3%; p < 0.001) compared to controls. This suboptimal bowel preparation, a recognized challenge in the evaluation of constipation, not only impacts the quality of colonoscopy but also results in a decreased cecal intubation rate (96.1% vs. 85% and 84%; p < 0.001).…”

Patient and healthcare professionals' perceptions of a combined blood and faecal immunochemical test for excluding colorectal cancer diagnosis in primary care

“… 21 However, studies have reported that those undergoing colonoscopy were twice as likely to have inadequate bowel preparation compared to the general population, 22 , 23 a higher rate of procedural failure, 22 with lesions more likely to be missed. 24 The Raman blood test alone was thought to have an important role for these patients. Further research is needed to understand the utility and acceptability of Raman‐FIT or Raman alone specifically in these patient groups.…”

Focal Active Colitis: What Are Its Clinical Implications? A Narrative Review

“…FAC is an inflammatory pattern that may or may not be clinically relevant. It is most observed in adult patients with bowel preparation artifacts [9,10,[29][30][31][32][33], infectious colitis, drug-induced gastrointestinal injuries, and IBS. Less frequently, it may manifest as IBD [34,35], such as CD or partially treated UC.…”