Reducing Suboptimal Bowel Preparation

Achieving adequate bowel cleansing is essential to ensuring safe and effective colonoscopy. Yet, among hospitalized patients, suboptimal bowel preparation is a common problem leading to diagnostic delay, increased cost, and patient dissatisfaction. All patients, inpatient and outpatient, presenting with inadequate bowel preparation prior to procedure require repeat colonoscopy sooner than needed with successful bowel preparation.

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Tu1045 Gastroenterologist Opinion Varies Widely in Interval to Repeat Colonoscopy With Inadequate Bowel Preparation

Gastroenterology ◽

10.1016/s0016-5085(14)62668-8 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-736-S-737

Author(s):

Jodie A. Barkin ◽

Daniel A. Sussman ◽

James S. Leavitt ◽

Jamie S. Barkin

Keyword(s):

Bowel Preparation ◽

Repeat Colonoscopy ◽

Inadequate Bowel Preparation

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Educational nurse-led telephone intervention shortly before colonoscopy as a salvage strategy after previous bowel preparation failure: a multicenter randomized trial

Endoscopy ◽

10.1055/a-1178-9844 ◽

2020 ◽

Vol 52 (11) ◽

pp. 1026-1035 ◽

Cited By ~ 1

Author(s):

Marco Antonio Alvarez-Gonzalez ◽

Miguel Ángel Pantaleón Sánchez ◽

Belén Bernad Cabredo ◽

Ana García-Rodríguez ◽

Santiago Frago Larramona ◽

...

Keyword(s):

Bowel Preparation ◽

Protocol Analysis ◽

Controlled Trial ◽

Intervention Group ◽

Telephone Intervention ◽

Intention To Treat ◽

Bowel Cleansing ◽

Significant Difference ◽

Inadequate Bowel Preparation ◽

And Control

Background The most important predictor of unsuccessful bowel preparation is previous failure. For those patients with previous failure, we hypothesized that a nurse-led educational intervention by telephone shortly before the colonoscopy appointment could improve cleansing efficacy. Methods We performed a multicenter, endoscopist-blinded, randomized controlled trial. Consecutive outpatients with previous inadequate bowel preparation were enrolled. Both groups received the same standard bowel preparation protocol. The intervention group also received reinforced education by telephone within 48 hours before the colonoscopy. The primary outcome was effective bowel preparation according to the Boston Bowel Preparation Scale. Intention-to-treat (ITT) analysis included all randomized patients. Per-protocol analysis included patients who could be contacted by telephone and the control cases. Results 657 participants were recruited by 11 Spanish hospitals. In the ITT analysis, there was no significant difference between the intervention and control groups in the rate of successful bowel preparation (77.3 % vs. 72 %; P = 0.12). In the intervention group, 267 patients (82.9 %) were contacted by telephone. Per-protocol analysis revealed significantly improved bowel preparation in the intervention group (83.5 % vs. 72.0 %; P = 0.001). Conclusion Among all patients with previous inadequate bowel preparation, nurse-led telephone education did not result in a significant improvement in bowel cleansing. However, in the 83 % of patients who could be contacted, bowel preparation was substantially improved. Phone education may therefore be a useful tool for improving the quality of bowel preparation in those cases.

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Predictors of Inadequate Bowel Preparation among Hospitalized Patients

The American Journal of Gastroenterology ◽

10.14309/00000434-201310001-02014 ◽

2013 ◽

Vol 108 ◽

pp. S611

Author(s):

Sreedevi Atluri ◽

Sofia Nigar ◽

Sandar Linn ◽

Manhal Olaywi ◽

Dunay Barsbay ◽

...

Keyword(s):

Bowel Preparation ◽

Hospitalized Patients ◽

Inadequate Bowel Preparation

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A2 THE BOWEL CLEANSING NATIONAL INITIATIVE (BCLEAN): PREDICTORS OF INADEQUATE BOWEL PREPARATION

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.001 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 2-3

Author(s):

A N Barkun ◽

M Martel ◽

I L Epstein ◽

P Hallé ◽

R J Hilsden ◽

...

Keyword(s):

Randomized Trial ◽

Bowel Preparation ◽

High Volume ◽

Random Allocation ◽

Charlson Score ◽

Split Dose ◽

Bowel Cleansing ◽

Low Residue Diet ◽

Low Volume ◽

Inadequate Bowel Preparation

Abstract Background Adequate bowel cleansing before colonoscopy is, in theory, a simple concept but the high rate of inadequate or incomplete bowel cleanliness and its consequences have been the subject of many studies, guidelines, and meta- analyses. The complexity resides in all the pre-endoscopic factors surrounding preparation intake that may? influence quality of the bowel preparation. Aims To identify preendoscopic variables associated with inadequate bowel preparation Methods In this randomized trial conducted in adult outpatients in 10 Canadian hospitals, all early morning (AM) colonoscopies were scheduled between 7h30AM and 10h30AM and patients were randomized to PEG low volume or high- volume split-dose or high- volume day before. Later colonoscopies (PM) were scheduled between 10h30AM and 16h30PM and patients were randomized to PEG low-volume or high- volume split-dose or low- volume same day. A secondary random allocation assigned patients to a clear fluid or low residue diet. Inadequate bowel preparation was identified on the Boston Bowel Preparation Scale with a total score <6 with any of the 3 colonic segments subscores <2). All preendoscopic variables such as patients related factors, diet and type of bowel preparation were evaluated between groups with chi-square, Fisher’s exact or t-test where appropriate. All variables found to be significantly associated with a clean preparation on univariable analysis at the P=0.15 level were used to construct a multivariable model. Because of stratified randomization by time with possible resulting differing confounders, AM and PM patients were analysed separately. Results Over 29 months, 1726 patients were stratified in the AM group and 1750 patients in the PM group. 16.9% had inadequate bowel preparation in the AM group and 9.8% in the PM group. Pre-endoscopic variables associated with an inadequate bowel cleanliness in AM colonoscopy were a non screening indication (OR 1.36, 95%CI 1.04–1.78), a Charlson score>0 (OR 1.36, 95% 1.03–1.80) and a low residue diet (OR 1.53, 95%CI 1.17–2.01). Amongst PM colonoscopies, variables associated with an inadequate bowel cleanliness were increased age (OR 1.03, 95% 1.01–1.04), a non screening indication (OR 1.90 95%CI 1.35–2.70); a Charlson score>0 (OR 1.63, 95%CI 1.15–2.32), and a low residue diet (OR 1.41, 95%CI 1.01; 1.98). Conclusions In this large randomized trial, amongst patients undergoing an AM colonoscopy, pre- endoscopic factors associated with an inadequate bowel preparation were a non screening indication, comorbidities and a low residue diet. Amongst PM colonoscopy patients, in addition to these variables, an increased age was also associated with an inadequate bowel preparation. Funding Agencies received arm-length funding from Pendopharm Inc.

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Prevalence of Missed Lesions in Patients with Inadequate Bowel Preparation Through a Very Early Repeat Colonoscopy

10.1055/s-0041-1724390 ◽

2021 ◽

Author(s):

MA Pantaleón Sánchez ◽

AZ Gimeno-García ◽

B Bernad Cabredo ◽

A García-Rodríguez ◽

S Frago Larramona ◽

...

Keyword(s):

Bowel Preparation ◽

Repeat Colonoscopy ◽

Inadequate Bowel Preparation

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VALIDATION OF A SCORE PREDICTING INADEQUATE BOWEL PREPARATION BEFORE COLONOSCOPY IN HOSPITALIZED PATIENTS

10.1055/s-0039-1681755 ◽

2019 ◽

Author(s):

K Triantafyllou ◽

P Gkolfakis ◽

A Skamnelos ◽

G Diamantopoulou ◽

A Dagas ◽

...

Keyword(s):

Bowel Preparation ◽

Hospitalized Patients ◽

Inadequate Bowel Preparation

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A multicenter, prospective, inpatient feasibility study to evaluate the use of an intra-colonoscopy cleansing device to optimize colon preparation in hospitalized patients: the REDUCE study

BMC Gastroenterology ◽

10.1186/s12876-021-01817-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Helmut Neumann ◽

Melissa Latorre ◽

Tim Zimmerman ◽

Gabriel Lang ◽

Jason Samarasena ◽

...

Keyword(s):

Feasibility Study ◽

Bowel Preparation ◽

Transverse Colon ◽

Bowel Movement ◽

Left Colon ◽

Hospitalized Patients ◽

Inpatient Setting ◽

Right Colon ◽

Colon Preparation ◽

Inadequate Bowel Preparation

Abstract Background High quality bowel preparation prior to colonoscopy can be difficult to achieve in the inpatient setting. Hospitalized patients are at risk for extended hospital stays and low diagnostic yield due to inadequate bowel preparation. The Pure-Vu System is a novel device intended to fit over existing colonoscopes to improve intra-colonoscopy bowel preparation. The objective of the REDUCE study was to conduct the first inpatient study to evaluate optimization of bowel preparation quality following overnight preparation when using the Pure-Vu System during colonoscopy. Methods This multicenter, prospective feasibility study enrolled hospitalized subjects undergoing colonoscopy. Subjects recorded the clarity of their last bowel movement using a 5-point scale prior to colonoscopy. After one night of preparation, all enrolled subjects underwent colonoscopy utilizing the Pure-Vu System. The primary endpoint was improvement of colon cleanliness from baseline to post-cleansing with the Pure-Vu System as assessed by the improvement in Boston Bowel Preparation Scale (BBPS). An exploratory analysis was conducted to assess whether the clarity of the last bowel movement could predict inadequate bowel preparation. Results Ninety-four subjects were included. BBPS analyses showed significant improvements in bowel preparation quality across all evaluable colon segments after cleansing with Pure-Vu, including left colon (1.74 vs 2.89; p < 0.0001), transverse colon (1.74 vs 2.91; p < 0.0001), and the right colon (1.41 vs 2.88; p < 0.0001). Prior to Pure-Vu, adequate cleansing (BBPS scores of ≥ 2) were reported in 60%, 62%, and 47% for the left colon, transverse colon, and right colon segments, respectively. After intra-colonoscopy cleansing with the Pure-Vu System, adequate colon preparation was reported in 100%, 99%, and 97% of the left colon, transverse colon, and right colon segments, respectively. Subjects with lower bowel movement clarity scores were more likely to have inadequate bowel preparation prior to cleansing with Pure-Vu. Conclusions In this feasibility study, the Pure-Vu System appears to be effective in significantly improving bowel preparation quality in hospitalized subjects undergoing colonoscopy. Clarity of last bowel movement may be useful indicator in predicting poor bowel preparation. Larger studies powered to evaluate clinical outcomes, hospital costs, and blinded BBPS assessments are required to evaluate the significance of these findings. Trial registration Evaluation of the Bowel Cleansing in Hospitalized Patients Using Pure-Vu System (NCT03503162).

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