Appointment waiting times and education level influence the quality of bowel preparation in adult patients undergoing colonoscopy

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Abstract

Background

Risk factors for poor bowel preparation are recognized to be independent of the type of bowel preparation method used. Patient and administrative factors influencing bowel preparation are known to vary in different healthcare systems.

Methods

A prospective, cross-sectional study of patients undergoing colonoscopy in an Asian tertiary centre was conducted to identify risk factors associated with poor bowel preparation, and to evaluate the impact of poor bowel preparation on technical performance and patient comfort.

Results

Data on 501 patients (mean age 60.1 ± 14.0 years old, 51.2% males, 60.9% with secondary education or higher) was available for analysis. Poor bowel preparation was present in 151 patients (30.1%). Lower education level (OR = 2.35, 95% CI = 1.54 - 3.60), colonoscopy appointment waiting time beyond 16 weeks (OR = 1.86, 95% CI = 1.04 - 3.37) and non-adherence to bowel preparation instructions (OR = 4.76, 95% CI = 3.00 - 7.55) were identified as independent risk factors for poor bowel preparation. Poor bowel preparation was associated with a lower cecal intubation rate (78.1% versus 98.3%, p < 0.001), prolonged total colonoscopy time (25.4 ± 12.6 minutes versus 16.7 ± 10.2 minutes, p < 0.001), and increased patient discomfort during colonoscopy (patient with moderate to severe abdominal discomfort 31.8% versus 3.2%, p < 0.001).

Conclusions

Education levels and appointment waiting times, in addition to non-adherence to bowel preparation instructions, increase the risk of poor bowel preparation in adult patients undergoing colonoscopy. The latter has a significant impact on colonoscopy performance and patient comfort.

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Most cited references 12

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Validation of a new scale for the assessment of bowel preparation quality.

Alaa Rostom, Emilie Jolicoeur (2004)

Bowel preparation quality scales are used to document the superiority of one preparation regime vs. another. The validity and reliability of these scales are not routinely stated in reports of studies in which the scales are used. A new colonoscopy bowel preparation scale (the Ottawa bowel preparation scale) was developed and validated prospectively. Ninety-seven consecutive patients undergoing elective outpatient colonoscopy were entered into the study. The quality of the bowel preparation was assessed independently by two investigators who used the Ottawa scale, and the only other validated scale (Aronchick scale) that could be identified. The interobserver agreement and reliability of each scale was assessed by the Pearson correlation coefficient (r), the intraclass correlation coefficient, and regression analysis. The Pearson correlation coefficients were, respectively, 0.89 and 0.62 for the Ottawa and Aronchick scales (p<0.001). The values for the kappa statistic, an intraclass correlation coefficient measuring agreement over and above chance agreement, were, respectively, 0.94 and 0.77 (p<0.001). Linear regression analysis, mapping the line best describing the scatter of scores by raters, for the Ottawa scale revealed a slope of the line of 0.93 and a y intercept of 0.10. The Aronchick scale revealed a slope of 0.65 and a y intercept of 0.46. The Ottawa scale thus was closer to an identity line comparing raters (i.e., closer to a line with slope of 1.00 and y intercept of 0.00). The Ottawa scale demonstrated a right colon kappa (intraclass correlation coefficient) of 0.92: 95% CI[0.88, 0.95], a mid colon kappa (intraclass correlation coefficient) of 0.88: 95% CI[0.82, 0.92], and a rectosigmoid kappa (intraclass correlation coefficient) of 0.89: 95% CI[0.83, 0.92]. The Ottawa scale was validated prospectively and demonstrates high interobserver agreement and reliability, whether used as a total score or for individual colon segments.

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Predictors of inadequate bowel preparation for colonoscopy.

N Chalasani, R Manam, H Hoen … (2001)

Inadequate preparation of the bowel for colonoscopy can result in both missed pathological lesions and cancelled procedures. We looked prospectively at the quality of colonic preparation and evaluated potential associations between specific patient characteristics and inadequate colonic preparation. Data were gathered on consecutive patients presenting for colonoscopy who received either a polyethylene glycol lavage or oral sodium phosphate bowel preparation. Patient demographic and medical history information was gathered before scheduled colonoscopy. The endoscopist evaluated the preparation quality during the procedure. Complete data were gathered on 649 of 714 eligible patients (90.8%). Possible predictors of inadequate colonic preparation were analyzed using univariate statistics and multivariate logistic regression models. An inadequate colonic preparation was reported in 21.7% of observed colonoscopies. Only 18% of patients with an inadequate colonic preparation reported a failure to adequately follow preparation instructions. A later colonoscopy starting time, a reported failure to follow preparation instructions, inpatient status, a procedural indication of constipation, taking tricyclic antidepressants, male gender, and a history of cirrhosis, stroke or dementia were all independent predictors of an inadequate colon preparation (all p < 0.05). A procedural indication of previous polypectomy was a negative predictor of inadequate colonic preparation (p < 0.05). Several patient characteristics were significantly associated with colonic preparation quality independent of preparation type, compliance with preparation instructions, and procedure starting time. This information may help to identify patients at an increased risk for inadequate colonic preparation for whom alternative preparation protocols would be appropriate.

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Asia Pacific consensus recommendations for colorectal cancer screening.

Michael C Wu, Joseph Sung, D. Bradford Brooks … (2008)

Colorectal cancer (CRC) is rapidly increasing in Asia, but screening guidelines are lacking. Through reviewing the literature and regional data, and using the modified Delphi process, the Asia Pacific Working Group on Colorectal Cancer and international experts launch consensus recommendations aiming to improve the awareness of healthcare providers of the changing epidemiology and screening tests available. The incidence, anatomical distribution and mortality of CRC among Asian populations are not different compared with Western countries. There is a trend of proximal migration of colonic polyps. Flat or depressed lesions are not uncommon. Screening for CRC should be started at the age of 50 years. Male gender, smoking, obesity and family history are risk factors for colorectal neoplasia. Faecal occult blood test (FOBT, guaiac-based and immunochemical tests), flexible sigmoidoscopy and colonoscopy are recommended for CRC screening. Double-contrast barium enema and CT colonography are not preferred. In resource-limited countries, FOBT is the first choice for CRC screening. Polyps 5-9 mm in diameter should be removed endoscopically and, following a negative colonoscopy, a repeat examination should be performed in 10 years. Screening for CRC should be a national health priority in most Asian countries. Studies on barriers to CRC screening, education for the public and engagement of primary care physicians should be undertaken. There is no consensus on whether nurses should be trained to perform endoscopic procedures for screening of colorectal neoplasia.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Gastroenterol

Title: BMC Gastroenterology

Publisher: BioMed Central

ISSN (Electronic): 1471-230X

Publication date Collection: 2011

Publication date (Electronic): 28 July 2011

Volume: 11

Page: 86

Affiliations

[1 ]Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

Article

Publisher ID: 1471-230X-11-86

DOI: 10.1186/1471-230X-11-86

PMC ID: 3156748

PubMed ID: 21798022

SO-VID: 9644f7f8-c2a3-4229-9e13-bd40b91645e9

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Appointment waiting times and education level influence the quality of bowel preparation in adult patients undergoing colonoscopy

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Abstract

Background

Methods

Results

Conclusions

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Karger: Gastroenterology

Most cited references 12

Validation of a new scale for the assessment of bowel preparation quality.

Predictors of inadequate bowel preparation for colonoscopy.

Asia Pacific consensus recommendations for colorectal cancer screening.

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