Risk factors for inadequate bowel preparation: a validated predictive score
submitted 19 May 2016
accepted after revision 20 December 2016
10 March 2017 (online)
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.
- 1 Hassan C, Bretthauer M, Kaminski MF. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45: 142-150
- 2 Johnson DA, Barkun AN, Cohen LB. et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2014; 109: 1528-1545
- 3 Saltzman JR, Cash BD, Pasha SF. et al. Bowel preparation before colonoscopy. Gastrointest Endosc 2015; 81: 781-794
- 4 Chung YW, Han DS, Park KH. et al. Patient factors predictive of inadequate bowel preparation using polyethylene glycol: a prospective study in Korea. J Clin Gastroenterol 2009; 43: 448-452
- 5 Diez-Rodriguez R, Rascarachi G, Khaliulina T. et al. [Factors associated with colon cleansing measured with the Boston scale in routine clinical practice]. Gastroenterol Hepatol 2015; 38: 274-279
- 6 Hassan C, Fuccio L, Bruno M. et al. A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy. Clin Gastroenterol Hepatol 2012; 10: 501-506
- 7 Kim HG, Jeon SR, Kim MY. et al. How to predict adequate bowel preparation before colonoscopy using conventional polyethylene glycol: prospective observational study based on survey. Dig Endosc 2015; 27: 87-94
- 8 Menees SB, Kim HM, Wren P. et al. Patient compliance and suboptimal bowel preparation with split-dose bowel regimen in average-risk screening colonoscopy. Gastrointest Endosc 2014; 79: 811-820 .e813
- 9 Ness RM, Manam R, Hoen H. et al. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol 2001; 96: 1797-1802
- 10 Nguyen DL, Wieland M. Risk factors predictive of poor quality preparation during average risk colonoscopy screening: the importance of health literacy. J Gastrointestin Liver Dis 2010; 19: 369-372
- 11 Parra-Blanco A, Ruiz A, Alvarez-Lobos M. et al. Achieving the best bowel preparation for colonoscopy. World J Gastroenterol 2014; 20: 17709-17726
- 12 Corporaal S, Kleibeuker JH, Koornstra JJ. Low-volume PEG plus ascorbic acid versus high-volume PEG as bowel preparation for colonoscopy. Scand J Gastroenterol 45: 1380-1386
- 13 Chan WK, Saravanan A, Manikam J. et al. Appointment waiting times and education level influence the quality of bowel preparation in adult patients undergoing colonoscopy. BMC Gastroenterol 2011; 11: 86
- 14 Dik VK, Moons LM, Huyuk M. et al. Predicting inadequate bowel preparation for colonoscopy in participants receiving split-dose bowel preparation: development and validation of a prediction score. Gastrointest Endosc 2015; 81: 665-672
- 15 Longstreth GF, Thompson WG, Chey WD. et al. Functional bowel disorders. Gastroenterology 2006; 130: 1480-1491
- 16 Lai EJ, Calderwood AH, Doros G. et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69: 620-625
- 17 Appannagari A, Mangla S, Liao C. et al. Risk factors for inadequate colonoscopy bowel preparations in African Americans and whites at an urban medical center. South Med J 2014; 107: 220-224
- 18 Hautefeuille G, Lapuelle J, Chaussade S. et al. Factors related to bowel cleansing failure before colonoscopy: results of the PACOME study. United European Gastroenterol J 2014; 2: 22-29
- 19 Parra-Blanco A, Nicolas-Perez D, Gimeno-Garcia A. et al. The timing of bowel preparation before colonoscopy determines the quality of cleansing, and is a significant factor contributing to the detection of flat lesions: a randomized study. World J Gastroenterol 2006; 12: 6161-6166
- 20 Wiwanitkit V. Colonoscopy with and without occult blood test pre-screening: which is more cost effective for implementation for screening for colon cancer?. Asian Pac J Cancer Prev 2010; 11: 823-824
- 21 Church JM. Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy – timing is the key!. Dis Colon Rectum 1998; 41: 1223-1225