Introduction

Adequate colonic preparation is crucial for successful colonoscopy, ensuring optimal visualization of the colon and accurate diagnosis of potential abnormalities. Various factors have been implicated in influencing bowel preparation quality, including patient characteristics, dietary habits, and the chosen preparation regimen.

Aims & Methods

This study investigates factors influencing colonic preparation quality for colonoscopy, focusing on the last bowel movement appearance, body mass index (BMI), diabetes mellitus, diet duration, and age.
We prospectively analyzed data from 158 patients undergoing colonoscopy between August and September 2023. Bowel preparation quality was assessed using a pre-endoscopy visual aid based on the color of the patient's last bowel movement an hour before the procedure. Additionally, we compared the 1-day vs. 4-day bowel preparation regimens.

Results

Conclusion

This study highlights the effectiveness of the pre-endoscopy visual aid in predicting bowel preparation adequacy. While diabetes adversely affects bowel preparation success, BMI and age above 70 years old are also associated with higher rates of inadequate preparation. Extending diet duration from 1 to 4 days significantly improves colonic preparation quality.

Introduction

A good bowel preparation for colonoscopy is fundamental to improve the quality of the examination, reduce procedural complications and achieve optimal polyp detection. Among possible strategies to enhance bowel preparation, visual booklets have been proposed with conflicting results. Therefore we aimed to perform a systematic review with meta-analysis of randomized controlled studies (RCT) to ascertain whether booklets may be useful in this setting.

Aims & Methods

Literature search was performed in July 2022, in main databases (PUBMED, SCOPUS, ScienceDirect, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov). only RCTs were selected. The primary outcome was the quality of bowel preparation. Further outcomes were the adenoma detection rate (ADR), number of polyps detected per patient, rate of cecal intubation, time of insertion and withdrawal, adverse events, willingness to repeat preparation and colonoscopy. We estimated odd ratios (OR) for dichotomous outcomes. mean differences (MD) or standardized mean differences (SMD) were used for continuous outcomes. We estimated heterogeneity among studies with the Chi2 (Cochran Q) and the I2 statistics. In case of high heterogeneity, a random effect model was used, otherwise a fixed effects model was preferred. All analyses were performed using RevMan version 5.4.1.

Results

Six studies were selected, enrolling overall 1755 patients (857 in the booklet and 898 in the control group). Adequate bowel preparation was achieved in the 86.7% (743 out of 857) of booklet preparation versus the 77.5% (696 out of 898) in the control group, with an OR of 2.31 in favour of booklet (95% CI 1.20-4.45, p = 0.01). Booklet was more effective than control in the transverse colon (MD = 0.37, 95% CI 0.01-0.72, p = 0.03), while no differences were found in right colon and left colon. In four studies a 4-L PEG-based preparation was used and the pooled analysis did not find any difference compared to controls, while when sodium phosphate and magnesium citrate or sodium phosphate or PEG were used, preparation with booklet was better than in controls (OR = 5.10, 95% CI 1.82-14.27, p = 0.002). Two studies were performed in inpatient setting, without difference between booklet and controls while in outpatients patients receiving booklets were better prepared than controls (OR = 7.13, 95% CI 5.39-9.45, p < 0.001). ADR was similar between the two groups, with an OR = 0.93 (95% CI 0.75-1.16, p = 0.53). The mean number of polyps per patient did not differ between the two groups (MD = 0.22, 95% CI -0.14-0.58, p = 0.23).

Conclusion

The present meta-analysis demonstrated that booklets are useful to enhance bowel preparation. Outpatients and non PEG-based preparations seem to benefit more from booklets, while no effect on ADR has been observed.

Introduction

Inadequate bowel preparation is linked to reduced adenoma detection rates (ADR), and establishing a threshold for bowel preparation below which colonoscopies should be repeated early is crucial for patient outcomes. However, manual bowel cleansing efficacy evaluation relies on the clinical observer's experience, resulting in subjectivity with clinical and economic implications. The Boston Bowel Preparation Scale (BBPS) is the most validated scoring scale. Our group previously constructed an AI-based bowel preparation assessment model to calculate e-BBPS scores.

Aims & Methods

This prospective, single-center study was conducted at the Eighth Affiliated Hospital, Sun Yat-sen University in China from October 2021 to November 2022. Eligible patients underwent screening colonoscopy by one of three study endoscopists. The AI calculated the e-BBPS score during colonoscope withdrawal. The endoscopist assessed bowel preparation adequacy using BBPS after the colonoscopy. If both BBPS and e-BBPS deemed bowel preparation adequate, the same endoscopist performed a second colonoscopy. If either considered it inadequate, the patient underwent bowel re-cleansing before the second colonoscopy. Video recordings were evaluated for bowel preparation using BBPS by five independent endoscopist raters.

Results

From October 8, 2021, to November 9, 2022, a total of 393 patients were included for analysis. In patients with unqualified-AI, the >5mm AMR was significantly higher than in patients with qualified-AI (p=0.0056, OR 0.2734, 95% CI 0.1139, 0.6565), as were the AMR <0.001 (p=0.2532, 95% CI 0.1583, 0.4052), diminutive AMR (p<0.001, OR 0.2160, 95% CI 0.1206, 0.3867), >5mm PMR (p=0.0152, OR 0.4335, 95% CI 0.2288, 0.8213), and PMR (p <0.001, OR 0.4532, 95% CI 0.3447, 0.5958). No significant differences were observed in the overall >5mm ADR, ADR, >5mm PDR, and PDR. In the first pass, no statistical differences were found in ADR between the qualified-AI and unqualified-AI groups, though there was a trend toward a higher ADR in the qualified-AI group. In the second pass, patients in the qualified-AI group achieved significantly lower >5mm ADR, ADR, diminutive ADR, advanced ADR, >5mm PDR, and PDR compared to those in the unqualified-AI group.
Cohen's kappa analysis revealed high agreement between expert raters, clinical scoring, and e-BBPS (ranging from 0.7791 to 0.8322). However, the agreement between general endoscopists and other raters was only low to moderate (0.2937 to 0.6071). Fleiss' kappa also indicated that the overall agreement among all raters was only 0.575 (p < 0.001, 95% CI 0.574, 0.575), while the Fleiss' kappa for Expert and Clinical scoring, as well as Expert, Clinical scoring, and e-BBPS were 0.809 (p < 0.001, 95% CI 0.807, 0.810) and 0.800 (p < 0.001, 95% CI 0.799, 0.801), respectively.

Conclusion

This study validates the e-BBPS bowel preparation evaluation threshold, confirming that patients with a score of ≤3 have adequate bowel preparation for detecting >5mm adenomatous polyps, while those with a score of >3 require repeat bowel preparation. This conclusion supports the implementation and promotion of fully automated bowel preparation assessment systems, which may improve the objectivity of bowel preparation evaluation and standardize clinical practice for screening colonoscopies in the future.

Introduction

The quality of a colonoscopy is heavily reliant on the effectiveness of bowel cleansing, which can impact the diagnostic accuracy and identification of adenomas. Various bowel cleansing products have been suggested, but their comparative effectiveness remains uncertain.

Aims & Methods

This systematic review and network meta-analysis aims to compare the performance of different bowel preparations for colonoscopy. MEDLINE, Embase, Scopus, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing the efficacy of different bowel preparations administered as split or same-day regimen. The primary outcome was cleansing success (CS) defined as a total BBPS score of ≥6. The secondary outcome was ADR.

Results

On network meta-analysis for CS (22 RCTs, 7179 patients, 14 bowel preparations assessed), 2L PEG+simethicone (RR=1.25 [95%CI=1.13-1.37]), 2L PEG+lactulose (RR=1.22 [95%CI=1.10-1.38]) and 1L PEG+ascorbate (ASC) (RR=1.03 [95%CI=1.01-1.06]) were significantly superior to 2L PEG+ASC. Overall, 2L PEG+lactulose resulted as the best product (SUCRA 0.94), followed by 2L PEG+simethicone (SUCRA 0.93), whereas 2L PEG+ASC showed the poorest performance. On network meta-analysis for ADR (17 RCTs, 6639 patients, 11 bowel preparations assessed), only 2L PEG+simethicone (RR=1.60 [95%CI=1.05-2.43]) resulted significantly superior to 2L PEG + ASC.

Conclusion

2L PEG+simethicone, 2L PEG+lactulose, and 1L PEG+ASC seemed to provide high rates of cleansing success, albeit only 2L PEG+simethicone was associated with a significantly higher ADR. Consequently, these products should be preferred for bowel preparation of colonoscopy. Further randomized studies with adequate sample sizes are needed for a more accurate comparison of these products on ADR.

Introduction

It is well known that inpatients more frequently undergo inadequate bowel preparation for colonoscopy, mainly due to factors such as old age, comorbidities and polypharmacy. we therefore aimed to investigate factors associated to inadequate bowel preparation in a group of hospitalized patients.

Aims & Methods

We prospectively enrolled inpatients at University Hospital Policlinico of Bari, who underwent colonoscopy in the last year. Outpatients undergoing colonoscopy represented a control group. For each patients we collected data about age, diseases and drugs consumed. all patients received a 4-L polyethilenglycole (PEG) based preparation in a split regimen, and colonoscopies were performed in the morning. Inadequate preparation was defined if Boston bowel preparation scale (BBPS) was total <6 or <2 in at least one colonic segment. Continuous and discrete variables were respectively compared by t-test and chi-square test. Binomial logistic regression was used to find factors associated to inadequate preparation and estimate of risk was defined as odds ratio (OR).

Results

We recruited 167 hospitalized patients and 167 controls. Inpatients were more commonly bedridden (p<0.001) or had chronic kidney disease (p=0.004) and were older than controls (64.7 ± 16.3 versus 50.9 ±18.6, p<0.001). Adequate preparation was attained only in the 73.6% of hospitalized patients versus the 88.0% of outpatients (p=0.001), and the BBPS was lower in inpatients (6.8 ± 1.7 versus 5.8 ± 2.5, p<0.001). Adequate preparation was more often achieved if patients was admitted in Gastroenterology units than in other units (81.6% versus 67.7%, p=0.04). Adenoma detection rate was higher when preparation was adequate (28.5% versus 13.6%, p=0.05). At multivariate analysis, inadequate preparation was associated with admission in a ward other than Gastroenterology (OR=1.88).

Conclusion

Our results confirm that hospitalization negatively impact on the quality of bowel preparation for colonoscopy. Interestingly, admission in Gastroenterology Unit allows a better preparation, maybe due to a better care of medical and nurse personnel.

Introduction

Aims & Methods

Results

Conclusion

Introduction

Intubation of the terminal ileum (TI) is the gold standard for completion of colonoscopy.
Our aim was to assess if this objective was achieved in our centre between endoscopists using various bowel preparations.
Poly ethylene glycol 4000 Vs Magnesium sulphate combined with potassium and sodium sulphates were the two commonly used bowel preparations. Magnesium containing preparations must be used with caution and avoided in patients with renal insufficiency, cardiac disease or pre-existing electrolyte abnormality and patients on diuretic therapy.
The Boston Bowel Preparation Scale was developed to limit inter-observer variability in the rating of bowel preparation quality, while preserving the ability to distinguish various degrees of bowel cleanliness and is mainly designed for adults. There is no dedicated bowel preparation score available for paediatric colonoscopies, BBPS is being used for critical comparison in our prospective cohort.

Aims & Methods

Objectives: To compare the intubation rate of TI between two endoscopists with quality of bowel preparation of colonoscopies in a tertiary health care centre and to assess the quality of bowel preparation of individual colonoscopies performed vis-a-vis, Boston bowel preparation scale as a prospective study over a period of 1 year.
Material and methods: A prospective study in a tertiary referral centre in children who underwent colonoscopies, aged 1 month to 17 years over a period of 1 year.
All children whose parents consented were included in the study. Results were collated using Microsoft Excel ™.A total of 135 cases were enrolled during our study period.

Results

1. TI intubation rate in PEG-4000 + bisacodyl based laxative formula is 87%
2. TI intubation rate in Magnesium/sodium/potassium based saline laxative formula is 79%
3. No side effects were encountered/ observed in either of the cohort.

Conclusion

In our study albeit the fact that our endoscopist chose different bowel preparations based on their anecdotal evidence based experience, we found that the bowel preparation was adequate.
There was no standardised paediatric bowel preparation globally and we note that every hospital or department or clinician have devised their own bowel preparation based either on personal experience or current available scientific literature.
We also note that we do not have a BBPS for paediatrics which will of immense value for research evaluation and revalidation of bowel preps.

References

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2. Goodman and Gilman’s The pharmacological basis of therapeutics., 13^th edition
3. Mamula, Petar, and Noor Nema. “Bowel Preparation for Pediatric Colonoscopy.” Frontiers in pediatrics vol. 9 705624. 1 Sep. 2021
4. Barraclough H, Gillett P, Basude D, et al OC68 A multicentre assessment of adequacy of bowel preparation for paediatric ileocolonoscopy using the Boston bowel preparation scale (BBPS) Frontline Gastroenterology 2023;14:A42.