Odds of Incomplete Colonoscopy in Colorectal Cancer Screening Based on Socioeconomic Status

The aim of this study is to investigate the association between socioeconomic status (SES) and the risk of having an incomplete colonoscopy (IC) in the Danish Colorectal Cancer (CRC) Screening Program. In this register-based study we included 71,973 participants who underwent colonoscopy after a positive fecal immunochemical test in the Danish CRC Screening Program. The main exposure, SES, was defined by income and education, and the outcome by complete or incomplete colonoscopy. Among the participants, 5428 (7.5%) had an incomplete colonoscopy. The odds ratio (OR) for ICs due to inadequate bowel preparation was 1.67 (95% CI: 1.46; 1.91) for income in the 1 quartile compared to income in the 4th quartile. ORs for income in the 2nd quartile was 1.38 (95% CI: 1.21; 1.56) and 1.17 (95% CI: 1.03; 1.33) for income in the 3rd quartile. For the educational level, an association was seen for high school/vocational education with an OR of 0.87 (95% CI: 0.79; 0.97) compared to higher education. For ICs due to other reasons, the level of income was associated with the risk of having an IC with an OR of 1.19 (95% CI: 1.05; 1.35) in the 1st quartile and an OR of 1.19 (95% CI: 1.06; 1.34) in the 2nd quartile. For the educational level, there were no significant associations. Low income is associated with high risk of having an IC, whereas educational level does not show the same unambiguous association.

Validation and Application of Predictive Models for Inadequate Bowel Preparation in Colonoscopies in a Tertiary Hospital Population

<b><i>Background:</i></b> Bowel preparation is a major quality criterion for colonoscopies. Models developed to identify patients with inadequate preparation have not been validated in external cohorts. We aim to validate these models and determine their applicability. <b><i>Methods:</i></b> Colonoscopies between April and November 2019 were retrospectively included. Boston Bowel Preparation Scale ≥2 per segment was considered adequate. Insufficient data, incomplete colonoscopies, and total colectomies were excluded. Two models were tested: model 1 (tricyclic antidepressants, opioids, diabetes, constipation, abdominal surgery, previous inadequate preparation, inpatient status, and American Society of Anesthesiology [ASA] score ≥3); model 2 (co-morbidities, tricyclic antidepressants, constipation, and abdominal surgery). <b><i>Results:</i></b> We included 514 patients (63% males; age 61.7 ± 15.6 years), 441 with adequate preparation. The main indications were inflammatory bowel disease (26.1%) and endoscopic treatment (24.9%). Previous surgery (36.2%) and ASA score ≥3 (23.7%) were the most common comorbidities. An ASA score ≥3 was the only identified predictor for inadequate preparation in this study (<i>p</i> &#x3c; 0.001, OR 3.28). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of model 1 were 60.3, 64.2, 21.8, and 90.7%, respectively. Model 2 had a sensitivity, specificity, PPV, and NPV of 57.5, 67.4, 22.6, and 90.5%, respectively. The AUC for the ROC curves was 0.62 for model 1, 0.62 for model 2, and 0.65 for the ASA score. <b><i>Conclusions:</i></b> Although both models accurately predict adequate bowel preparation, they are still unreliable in predicting inadequate preparation and, as such, new models, or further optimization of current ones, are needed. Utilizing the ASA score might be an appropriate approximation of the risk for inadequate bowel preparation in tertiary hospital populations.

The Prediction of Inadequate Colon Capsule Cleansing: A Cohort Selection Guided by CC-CLEAR

<b><i>Introduction:</i></b> In order to optimize the rate of adequate cleansing in colon capsule, it may be important to identify risk factors that can predict a suboptimal colon preparation. <b><i>Aim:</i></b>To define predictive factors for inadequate bowel preparation in colon capsule, according to CC-CLEAR (Colon Capsule CLEansing Assessment and Report). <b><i>Methods:</i></b> Retrospective, single center, cohort study. Patients’ demographics, data, and quality of bowel preparation, according to CC-CLEAR, were collected retrospectively. A univariate analysis tested the association between covariables and the outcome, inadequate cleansing. The statistically significant variables were included in multivariable logistic binary regression, and a receiver operating characteristic curve (ROC) assessment was performed. <b><i>Results:</i></b> We included 167 consecutive colon capsules. Sixty-eight percent (<i>n</i> = 114) of patients were female, with a mean age of 64 years. The main indication for colon capsule was previous incomplete colonoscopy, in 158 patients (94.6%). The colon capsules cleansing was graded as good or excellent in 96 patients (57.5%) and as inadequate in 71 (42.5%), according to CC-CLEAR. The variables inadequate previous colon cleansing (OR adjusted 41.72 [95% CI 12.57–138.57], <i>p</i> value &#x3c; 0.001); chronic laxative (OR adjusted 4.86 [95% CI 1.08–21.79], <i>p</i> value = 0.039); antidepressant (OR adjusted 5.00 [95% CI 1.65–15.16], <i>p</i> value = 0.004), and impaired mobility (OR adjusted 5.54 [95% CI 1.17–26.31], <i>p</i> value = 0.031) were independently associated with the outcome inadequate cleansing, after adjusting for confoundment. The model presented an excellent discriminative power towards the outcome variable (AUC ROC 0.937 [CI 95% 0.899–0.975], <i>p</i> value &#x3c; 0.001). <b><i>Conclusion:</i></b> A previous inadequate colon cleansing, the use of chronic laxative and antidepressant, or impaired mobility are predictors of inadequate colon capsule cleansing, as assessed by the CC-CLEAR. These 4 predictors come together as a model enabling an accurate categorization of the patients at major risk of inadequate bowel preparation for capsule colonoscopy, with an excellent discriminative power and performance, which seems useful for the selection of patients for tailored optimization of the colon cleansing protocol.

Effect of physician-provided education on the quality of bowel preparation

Background and study aims : Inadequate bowel preparation inpatients scheduled for colonoscopy is an important problem. Inour study, we aimed to investigate the effect of physician-providedbowel preparation education on the quality of bowel preparationand process. Patients and methods : A total of 150 outpatients who were referredto Kocaeli University Medical Faculty Hospital GastroenterologyUnit for colonoscopy between May 2019 and October 2019 wereenrolled in our prospective, endoscopist-blinded study. Patientswere divided into two groups. Group 1 (education group) included73 patients who received 10 minutes of verbal information froma physician in addition to a written information form. Group 2(control group) included 75 patients who received informationfrom a medical secretary in addition to a written information form.During colonoscopy, the quality of bowel preparation was assessedusing the Boston bowel preparation scale (BBPS). A BBPS score≥ 5 was considered adequate bowel preparation. The mean BBPSscore, polyp detection rate, cecal intubation rate and time, andprocedure time were also evaluated. Results : The rate of adequate bowel preparation (BBPS score≥ 5) was 90.4% and 74.7% in groups 1 and 2, respectively (p =0.021). The odds ratio for having a BBPS score ≥ 5 in the educationgroup was 3.199 compared with the control group (95% confidenceinterval = 1.254-8.164; p = 0.015). The cecal intubation rates were91.8% and 88% in groups 1 and 2, respectively (p > 0.05). The cecalintubation time, procedure time, and adenoma detection rates weresimilar between the groups. The relationships of age, educationlevel, sex, diabetes mellitus, medicine use, procedure time, andintraabdominal surgery with inadequate bowel preparationwere analysed using a logistic regression model. Univariate andmultivariate analyses revealed no significant factors associatedwith inadequate bowel preparation. Conclusions : Patient education on the bowel preparationprocess via a physician improved the quality of bowel preparation.

Risk Factors of Inadequate Bowel Preparation for Screening Colonoscopy

The success of a colonoscopy in detecting and removing pre-cancerous and cancerous lesions depends heavily on the quality of bowel preparation. Despite efforts, 20–44% of colonoscopy participants have an inadequate bowel preparation. We aimed to assess and compare risk factors for inadequate bowel preparation and for the presence of advanced colorectal neoplasms in routine screening practice. In this cross-sectional study, among 8125 participants of screening colonoscopy in Germany with a comprehensive assessment of sociodemographic factors, lifestyle and medical history, we examined factors associated with inadequate bowel preparation and with findings of advanced neoplasms using adjusted log-binomial regression models. Among the identified risk factors assessed, three factors were identified that were significantly associated with inadequate bowel preparation: age ≥ 70 years (adjusted prevalence ratios, aPR, 1.50 95%CI 1.31–1.71), smoking (aPR 1.29 95%CI 1.11–1.50) and abdominal symptoms (aPR 1.14 95%CI 1.02–1.27). The same risk factors were also associated with the prevalence of advanced neoplasms in our study (aPR 1.72, 1.62 and 1.44, respectively). The risk factors associated with inadequate bowel preparation in this study were also associated with a higher risk for advanced neoplasms. Inadequate bowel preparation for colonoscopy might lead to missed colorectal cancer (CRC) precursors and the late diagnosis of CRC. People at high risk of advanced neoplasms are in particular need of enhanced bowel preparation.