Endoscopy 2017; 49(06): 536-543
DOI: 10.1055/s-0043-101683
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Risk factors for inadequate bowel preparation: a validated predictive score

Antonio Z. Gimeno-García, Jose Luis Baute, Goretti Hernandez, Dalia Morales, Carmen Delia Gonzalez-Pérez, David Nicolás-Pérez, Onofre Alarcon-Fernández, Alejandro Jiménez, Manuel Hernandez-Guerra, Rafael Romero, Inmaculada Alonso, Yanira Gonzalez, Zaida Adrian, Marta Carrillo, Laura Ramos, Enrique Quintero
  • Gastroenterology Department and Research Unit, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
Further Information

Publication History

submitted 19 May 2016

accepted after revision 20 December 2016

Publication Date:
10 March 2017 (eFirst)

Abstract

Background and study aim Inadequate bowel cleansing negatively affects the efficiency of colonoscopy in routine clinical practice. The aim of this study was to design and validate a predictive model for inadequate bowel cleanliness.

Patients and methods The model was built from 667 consecutive outpatients (development cohort) who were prospectively scheduled for colonoscopy between June and September 2014. The validation cohort included 409 outpatients who underwent colonoscopy between October and December 2014. Cleansing was evaluated using the Boston Bowel Preparation Scale (BBPS). Bowel preparation was administered on the same day as the examination.

Results In the development cohort, BBPS was adequate in 541 patients (81.1 %). At multivariate analysis, antidepressants (odds ratio [OR] 4.25, 95 % confidence interval [CI] 1.91 – 9.47), co-morbidity (OR 3.35, 95 %CI 2.16 – 5.18), constipation (OR 2.09, 95 %CI 1.29 – 3.40), and abdominal/pelvic surgery (OR 1.60, 95 %CI 1.03 – 2.47) were independent predictors for inadequate cleansing. The model built with these variables showed an area under the curve of 0.72 in the development cohort and 0.70 in the validation cohort. A cutoff of 1.225 predicted inadequate bowel preparation with a sensitivity, specificity, positive predictive value, and negative predictive value of 60.3 % (95 %CI 51.6 – 68.4), 75.4 % (95 %CI 71.6 – 78.9), 36.4 % (95 %CI 30.1 – 43.1), and 89.1 % (95 %CI 85.9 – 91.6) in the development cohort, and 50.0 % (95 %CI 38.1 – 61.9), 80.0 % (95 %CI 75.3 – 84.2), 35.7 % (95 %CI 26.4 – 45.6), and 87.9 % (95 %CI 83.7 – 91.3) in the validation cohort.

Conclusion A simple score may assist the clinician in predicting which patients are at high risk of inadequate bowel cleanliness. This may guide changes in bowel preparation strategy accordingly.

Appendix e1 – e2