Patient Factors Predictive of Inadequate Bowel Preparation Using Polyethylene Glycol

Chung, Yong Woo; Han, Dong Soo; Park, Kwang Hyuk; Kim, Kyoung Oh; Park, Cheol Hee; Hahn, Taeho; Yoo, Kyo-Sang; Park, Sang Hoon; Kim, Jong Hyeok; Park, Choong Kee

doi:10.1097/mcg.0b013e3181662442

Cited by 178 publications

(163 citation statements)

References 23 publications

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“…In most publications, randomized clinical trials investigated the quality of bowel cleansing using various preparations, but few studies were designed to identify factors associated with failure. Among recently published papers, we found observational studies [7][8][9][10]12,27,28 but no case-control studies, which makes our work original and relevant for clinical application. The gastroenterologists enrolled were representative of French gastroenterologists for the type of activity and sex ratio: 73% had a private practice while 27% had a public hospital-based practice, and these data are similar with those of the whole French gastroenterologist population according to a professional French database (CEGEDIM) including 3720 gastroenterologists.…”

Section: Discussionmentioning

confidence: 99%

Factors related to bowel cleansing failure before colonoscopy: Results of the PACOME study

et al. 2014

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Background: The factors associated with inadequate bowel cleansing leading to colonoscopy failure are not well known. Objective: We conducted a multicentre, prospective, observational case-control study in order to identify these factors. Methods: Investigators included one patient with colonoscopy failure due to inadequate bowel cleansing (failure group) and the following patient with complete colonoscopy (success group). Data related to demographics, medical history, and preparation were collected and compared. Factors associated with bowel cleansing failure were identified by multivariate logistical regression analysis. Results: A total of 101 gastroenterologists included 202 patients from 1 November 2009 to 15 January 2010. There was no difference between both groups with regards to baseline characteristics. In univariate analysis, factors significantly associated with bowel cleansing failure were vomiting during preparation (p ¼ 0.0007), incomplete intake of the preparation (p ¼ 0.002), and constipation (p ¼ 0.02). Type and timing of preparation were not significantly different between groups. In multivariate analysis, incomplete intake of the preparation (OR 4.5, 95% CI 1.2-17.3), constipation (OR 4.2, 95% CI 1.2-14.9), and treatment with neuroleptics or antidepressants (OR 9.9 (95% CI 1.4-71.0) were independent predictors of colonoscopy failure. Conclusions: Factors associated with bowel cleansing failure were incomplete intake of the preparation, constipation, and treatment with psychotropic drugs. Interventions to reduce poor colonoscopy preparations should be targeted at these at-risk patients.

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Section: Discussionmentioning

confidence: 99%

Factors related to bowel cleansing failure before colonoscopy: Results of the PACOME study

et al. 2014

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“…[6][7][8] In addition, poor tolerance of preparation often results in an incomplete examination of these patients. 9 In the present study, we found that flexible sigmoidoscopy is a safe initial investigation for elderly patients who present with specific lower gastrointestinal symptoms. Our data demonstrate that FS is a useful investigation in patients who present with PR bleeding, have a history of polyps or have a radiological abnormality in the left-sided colon.…”

Section: Discussionmentioning

confidence: 78%

Investigating the frail elderly patient with lower bowel symptoms: what do we do now and can we improve?

2013

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-Aims: To assess the utility of flexible sigmoidoscopy (FS) and minimal preparation CT (MPCT) in investigating lower gastrointestinal (LGI) symptoms in elderly patients who are too frail to undergo colonoscopy or spiral CT. IntroductionColonic symptoms are common in the general population. Options for investigating these include flexible sigmoidoscopy (FS), colonoscopy, barium enema and contrast computer-tomography (CT) studies. Colonoscopy is seen as the 'gold standard' test for visualising the whole colon directly, excluding neoplasia and obtaining histological samples, but it might not be the best choice in the frail elderly. The risks of sedation, the patient's ability to take and retain the bowel preparation and cope with the ensuing diarrhoea and dehydration, and the requirement to change position during the test must be carefully assessed, and other investigations considered. 1 In patients who are unlikely to tolerate colonoscopy safely or effectively, FS can be used with or without minimal preparation CT (MPCT). FS requires an enema only and is performed without sedation. Preparation for MPCT requires 700 ml oral contrast without laxative the night before and another 700 ml oral contrast on the day of the examination. This technique has a sensitivity of 85-90% for detecting advanced neoplasia. [2][3][4][5] MPCT allows views of the whole colon, which are poorer than those provided by CT colonography or colonoscopy, and have resulted in patients often having FS as well. ObjectivesThe aim of this study was to investigate the utility of flexible sigmoidoscopy as a diagnostic tool in the assessment of frail older patients with colonic symptoms who were not perceived to be medically fit for colonoscopy or spiral CT colonography. We evaluated the indications, yield of positive findings and patient tolerance of FS and examined whether FS findings correlate with those from imaging. In particular, we assess whether FS is useful at all for this discrete and vulnerable population, and if so, in what situations. Methods Patient selectionWe reviewed all flexible sigmoidoscopies performed in patients over 70 years between 1 January and 31 December 2008 in University Hospital Lewisham. Information was collected prospectively using an endoscopy database. Data that were analysed included: age, gender, indication for procedure, patient's American Society of Anesthesiologists (ASA) grade, adequacy of preparation, extent of examination, endoscopic diagnosis and need for further lower GI investigation. Key points1 There is a need to rationalise lower gastrointestinal investigations in elderly patients who are too frail to undergo colonoscopy or CT colonography.

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“…19 These mechanisms may also occur in patients with a previous colorectal surgery and interfere with the polyp retrieval ratio. Of note: Although a previous colorectal surgery has been associated to inadequate bowel preparation, 20,21 these two factors were independent in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for polyp retrieval failure in colonoscopy

et al. 2015

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Introduction: Colonoscopy is able to diagnose, resect and retrieve colonic polyps. Although retrieval of resected polyps is still globally advised, it is not always successful. We aimed to define the risk factors for polyp retrieval failure in colonoscopy. Methods: A single-center, retrospective study assessed 3507 consecutive and non-urgent colonoscopies, performed between September 2011 and December 2012. Colonoscopies were included in our analysis if the diagnosis of at least one polyp was established, and one or more snare polypectomies were performed. Demographic and technical data were collected according to the patient's endoscopy report. Results: A total of 1109 polyps were analyzed, corresponding to 496 colonoscopies from 483 different patients. We found that 53 (4.8%) of the resected polyps were not retrieved. In a univariate analysis, the factors associated with polyp retrieval failure were: age, polyp size, resection technique, bowel preparation, location and the presence of a previous colorectal surgery (p < 0.05). In the multivariate analysis, a previous colorectal surgery, resection by cold snare, location in the right colon, inadequate bowel preparation and a polyp size up to 5 mm were independently associated with higher polyp retrieval failure (p < 0.05). Discussion: Different and well-defined factors were associated with polyp retrieval failure. Because bowel preparation was the only modifiable factor identified, a special focus should be given to this topic.

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Patient Factors Predictive of Inadequate Bowel Preparation Using Polyethylene Glycol

Cited by 178 publications

References 23 publications

Factors related to bowel cleansing failure before colonoscopy: Results of the PACOME study

Factors related to bowel cleansing failure before colonoscopy: Results of the PACOME study

Investigating the frail elderly patient with lower bowel symptoms: what do we do now and can we improve?

Risk factors for polyp retrieval failure in colonoscopy

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