La coloscopie en France en 2008: résultats de l’enquête de deux jours d’endoscopie en France

Risk Factors for Inadequate Bowel Preparation During Colonoscopy in Nigerian Patients

Background The past few decades have witnessed the introduction of various innovative technologies into colon study by colonoscopy. A well-prepared bowel is crucial to their effective utilization. An inadequate bowel preparation during colonoscopy is associated with increased technical difficulties, enhanced risks of perforation, longer examination durations, reduced adenoma detection rates, and additional costs related to repeated colonoscopies. There is a paucity of literature from Africa on the multiple patient factors that affect the quality of bowel preparation; hence, the need to identify patients at risk for inadequate bowel preparation to allow for more diligence in this special group. Aim To study the risk factors of inadequate bowel preparation for colonoscopy and identify the group of patients who need intensified preparation in a Nigerian population. Methods A case-control study of consecutive patients undergoing colonoscopy in an open access/referral-based multi-disciplinary endoscopy facility in Port Harcourt metropolis, Nigeria from March 2014 to November 2020. Consecutive adult patients who underwent colonoscopy with inadequate bowel preparation irrespective of the indication were retrospectively identified. Each case of inadequate bowel preparation while using a particular bowel preparation agent was matched with the next colon study with adequate bowel preparation (control) for the same agent in a 1:1 ratio. The variables collated were age, gender, literacy level, colonoscopy indication, medical history, bowel preparation agent, timing of endoscopy, and outcome. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25 (IBM Corp., Armonk, NY). Results There were 143 cases of inadequate bowel preparation during colonoscopy included in the study with an equal number of control (cases of adequate bowel preparation). The age of patients ranged from 24 years to 92 years. Bleeding per rectum - 122(42.7%), and screening for colorectal cancer - 67(23.4%), were the leading indications for colonoscopy in study patients. Bivariate analysis of cases and controls revealed significant difference in educational status, comorbidity of hypertension, and constipation (p < 0.01, p = 0.082, p = 0.143, respectively). In the multivariate analysis of risk factors, the odds ratio (OR) for secondary level of education and below was 2.54 (95% confidence interval CI 1.50-4.30; p = 0.001); hypertension - OR 1.64 (95% CI 0.98-2.73; p = 0.058); constipation - OR 1.27 (95% CI 0.52-3.10; p = 0.598). Conclusion The educational status of patients is a strong risk factor associated with inadequate bowel preparation for colonoscopy in this Nigerian population. There is a need for effective patient education especially for patients with a low literacy level.

Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta-analysis

BACKGROUND

Bowel preparation for colonoscopy is often poorly tolerated due to poor palatability and adverse effects. This can negatively impact on the patient experience and on the quality of bowel preparation. This systematic review and meta-analysis was carried out to assess whether adjuncts to bowel preparation affected palatability, tolerability and quality of bowel preparation (bowel cleanliness).

METHODS

A systematic search strategy was conducted on PubMed, MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews to identify studies evaluating adjunct use for colonoscopic bowel preparation. Studies comparing different regimens and volumes were excluded. Specific outcomes studied included palatability (taste), willingness to repeat bowel preparation, gastrointestinal adverse events and the quality of bowel preparation. Data across studies were pooled using a random-effects model and heterogeneity assessed using I2-statistics.

RESULTS

Of 467 studies screened, six were included for analysis (all single-blind randomised trials; n = 1187 patients). Adjuncts comprised citrus reticulata peel, orange juice, menthol candy drops, simethicone, Coke Zero and sugar-free chewing gum. Overall, adjunct use was associated with improved palatability (mean difference 0.62, 95% confidence interval 0.29-0.96, p < 0.001) on a scale of 0-5, acceptability of taste (odds ratio 2.75, 95% confidence interval: 1.52-4.95, p < 0.001) and willingness to repeat bowel preparation (odds ratio 2.92, 95% confidence interval: 1.97-4.35, p < 0.001). Patients in the adjunct group reported lower rates of bloating (odds ratio 0.48, 95% confidence interval: 0.29-0.77, p = 0.003) and vomiting (odds ratio 0.47, 95% confidence interval 0.27-0.81, p = 0.007), but no difference in nausea (p = 0.10) or abdominal pain (p = 0.62). Adjunct use resulted in superior bowel cleanliness (odds ratio 2.52, 95% confidence interval: 1.31-4.85, p = 0.006). Heterogeneity varied across outcomes, ranging from 0% (vomiting) to 81% (palatability), without evidence of publication bias. The overall quality of evidence was rated moderate.

CONCLUSION

In this meta-analysis, the use of adjuncts was associated with better palatability, less vomiting and bloating, willingness to repeat bowel preparation and superior quality of bowel preparation. The addition of adjuncts to bowel preparation may improve outcomes of colonoscopy and the overall patient experience.

Factors related to bowel cleansing failure before colonoscopy: Results of the PACOME study

BACKGROUND

The factors associated with inadequate bowel cleansing leading to colonoscopy failure are not well known.

OBJECTIVE

We conducted a multicentre, prospective, observational case-control study in order to identify these factors.

METHODS

Investigators included one patient with colonoscopy failure due to inadequate bowel cleansing (failure group) and the following patient with complete colonoscopy (success group). Data related to demographics, medical history, and preparation were collected and compared. Factors associated with bowel cleansing failure were identified by multivariate logistical regression analysis.

RESULTS

A total of 101 gastroenterologists included 202 patients from 1 November 2009 to 15 January 2010. There was no difference between both groups with regards to baseline characteristics. In univariate analysis, factors significantly associated with bowel cleansing failure were vomiting during preparation (p = 0.0007), incomplete intake of the preparation (p = 0.002), and constipation (p = 0.02). Type and timing of preparation were not significantly different between groups. In multivariate analysis, incomplete intake of the preparation (OR 4.5, 95% CI 1.2-17.3), constipation (OR 4.2, 95% CI 1.2-14.9), and treatment with neuroleptics or antidepressants (OR 9.9 (95% CI 1.4-71.0) were independent predictors of colonoscopy failure.

CONCLUSIONS

Factors associated with bowel cleansing failure were incomplete intake of the preparation, constipation, and treatment with psychotropic drugs. Interventions to reduce poor colonoscopy preparations should be targeted at these at-risk patients.