Introduction Inadequate bowel preparation reduces the diagnostic accuracy of colonoscopy. This has a significant impact on patients’ safety and the endoscopy units waiting lists. 90% adequate bowel preparation is a quality and safety indicator for endoscopy according to the Joint Advisory Group (JAG).
The aim of this study is to determine the effect of patient pre-assessment on the quality of bowel preparation. The role of the cleansing agent was also assessed.
Methods This is a retrospective observational study on consecutive patients undergoing elective colonoscopy in our centre from October 2014 until September 2015. Adults undergoing routine diagnostic colonoscopy, bowel cancer screening colonoscopy and chromoendoscopy were included.
Sodium picosulphate (PIC) was used as cleansing agent in the first two groups whereas pegylated ethylene glycol with senna (PEG) was used in the latter. According to duration pre-assessment was either limited (LIM, 15 mins) or prolonged (PRO, 45 mins). Quality of bowel preparation was rated as inadequate, adequate and excellent.
Results 2900 procedures were evaluated. 60% of the patients were male and the mean age was 58.8 +/- 15.68 years. 1670 (57.58%) were pre-assessed, of which 1329 received LIM/PIC, 280 PRO/PIC and 65 LIM/PEG. 1230 (42, 42%) were not preassessed and had PIC (NO/PIC).
Inadequate bowel preparation was reported in 13.31% (n = 386) of the whole cohort. The rate of inadequate bowel preparation in each group was: NO/PIC (17.8%), LIM/PIC (11.51%), LIM/PEG (10.77%), PRO/PIC (2.53%).
Pre-assessment showed significant association with bowel preparation outcome (p < 0.001), while the type of cleansing agent used had no impact on the quality of bowel preparation (p = 0.241).
Further multiple regression analysis showed that patients who had no pre-assessment were more likely to present with inadequate bowel preparation (OR 15.46, CI [7.15–33.4]) compared to patients who underwent prolonged preassessment. Patients undergoing limited preassessment were more likely to present with inadequate bowel preparation (OR 8.16, CI [3.76–17.70]) compared to patients who underwent prolonged pre-assessment.
Conclusion This study identifies a prognostic role of preassessment in bowel preparation for colonoscopy. The cleansing agent seems to have no effect but only a small number of patients receiving preparation with PEG were included in this study. Further analysis of more categorical independent variables is required to formulate a predictive model for inadequate bowel preparation.
Reference 1 R. Valori. BSG Quality and Safety Indicators for Endoscopy, March 2007 Joint Advisory Group.
Disclosure of Interest None Declared