Usefulness of Personal Bowel Habits as a Predictive Factor for Inadequate Bowel Preparation for Colonoscopy: A Prospective Questionnaire-Based Observational Study

Abstract

Background/AimsThe quality of bowel preparation is important for optimal colonoscopy. It is influenced by medical and personal factors. We aimed to evaluate the effect of bowel habit on the quality of bowel preparation and to identify predictors of inadequate bowel preparation among bowel habit factors.MethodsFrom June 2017 to September 2017, 90 volunteers were enrolled in this study. Each participant answered a questionnaire consisting of multiple questions about personal bowel habits, including stool form, frequency of bowel movements per week, duration, and degree of straining for bowel movement. Then, all volunteers underwent colonoscopic exam. Eleven endoscopists performed colonoscopies and used the Boston Bowel Preparation Scale (BBPS) as the index for bowel preparation. Two expert endoscopists simultaneously reviewed all colonoscopic images to confirm the final BBPS. Univariate and multivariate logistic regression analyses were performed to verify the correlation between bowel preparation adequacy and bowel habit.ResultsAmong the 90 participants, 20 (22.2%) had inadequate bowel preparation (total BBPS ≤6 or any segmental BBPS ≤1). In univariate analysis, infrequent bowel movement (0–2/week) (odds ratio [OR], 12.60; 95% confidence interval [CI], 1.22 to 129, p=0.03) and moderate straining (more than 1/4 of defecations) (OR, 4.40; 95% CI, 1.44 to 13.39; p=0.01) were significantly associated with inadequate bowel preparation. However, only moderate straining was significantly associated with inadequate bowel preparation in multivariate analysis (OR, 3.99; 95% CI, 1.26 to 12.65; p=0.02).ConclusionsStraining is a significant predictor for inadequate bowel preparation. For patients with straining during bowel movements, an intensified preparation regimen should be considered.

Educating Outpatients for Bowel Preparation Before Colonoscopy Using Conventional Methods vs Virtual Reality Videos Plus Conventional Methods

“… 4 , 19 Patients’ personal characteristics, including age, sex, body mass index, educational level, annual income, complications, and waiting time, can affect the quality of bowel preparation. 7 , 8 , 20 , 21 Thus, education becomes an important means to motivate patients and improve compliance for colonoscopy preparation. Studies have demonstrated the effectiveness of various patient educational methods to enhance bowel preparation.…”

“…Current guidelines also recommend early repeated colonoscopic procedures when bowel preparation quality is inadequate (any colon segment BBPS score <2) . Patients’ personal characteristics, including age, sex, body mass index, educational level, annual income, complications, and waiting time, can affect the quality of bowel preparation . Thus, education becomes an important means to motivate patients and improve compliance for colonoscopy preparation.…”

Optimization of colonoscopy quality: Comprehensive review of the literature and future perspectives

“…Implementing measures to improve patient compliance with bowel preparation protocols could significantly reduce colonoscopy costs, heighten adenoma identification, and decrease the risk of complications in clinical practice 24 . Several factors are linked to inadequate bowel preparation for colonoscopy, including age, male gender, inpatient status, high body mass index, comorbidities, narcotic use, constipation, patient compliance, education level, and the type of bowel preparation agent 41–46 . For enhanced efficacy and safety in bowel preparation and colonoscopy, endoscopic teams should consider a patient's medical conditions when choosing the ideal preparation agent and regimen.…”

“…24 Several factors are linked to inadequate bowel preparation for colonoscopy, including age, male gender, inpatient status, high body mass index, comorbidities, narcotic use, constipation, patient compliance, education level, and the type of bowel preparation agent. [41][42][43][44][45][46] For enhanced efficacy and safety in bowel preparation and colonoscopy, endoscopic teams should consider a patient's medical conditions when choosing the ideal preparation agent and regimen.…”

Personal instruction for patients before colonoscopies could improve bowel preparation quality and increase detection of colorectal adenomas

“…In clinical practice, the most feasible method to improve the patient's understanding and compliance with the bowel preparation methods is to hand out a standard bowel preparation result picture, and a flow chart mainly based on pictures to general patients during appointments (25)(26)(27), provide reeducation via telephone or text messaging (12,28), and send smartphone and social media reminders (29,30) before colonoscopy (31) to improve the quality of bowel preparation and adenoma detection (32). Especially for patients who are assessed as having poor bowel preparation (33,34), such as those with chronic constipation (35,36), should accept personal instruction using the above mentioned methods, or admit to daytime wards if necessary to improve the quality of the bowel preparation for practical colonoscopy examination.…”