Abstract
Purpose of review
Adequate bowel cleansing before colonoscopy is a simple concept but the high rate of inadequate or incomplete bowel cleanliness and its consequences have been the subject of many studies, guidelines, and meta-analysis. The complexity resides in all the factors surrounding preparation intake such as type and regimen of bowel preparation, diets, compliance, and also patient-related factors that all influence quality of the bowel preparation. The purpose of this review is to focus specifically on patient-related factors and their challenges. Patients with lower GI bleeding are excluded from this review.
Recent findings
Patient factors that may be associated with a poor bowel preparation were searched for in the literature. With regard to patient’s characteristics, higher age, male gender, and socio-economic status (lower income, Medicaid, and lower education) were all associated with higher rates of inadequate bowel preparation. Comorbidities such as inflammatory bowel disease (IBD), in-patients, body mass index (BMI), cirrhosis, constipation, and neurological condition as well as some pharmacotherapy were also associated with inadequate bowel preparation. Studies identifying predictive patient factors as well as those studying these patients in particular showed variability in the strength of the patient factor associations. Patients taking tricyclic antidepressant, narcotics, and those with neurological conditions were identified to have a stronger association with worse bowel cleanliness. Those can be implemented with the current recommendations of split-dosing.
Summary
Identifying individual factors that can impact the quality of bowel cleanliness can be challenging. Some have been well-studied in the literature such as age, in-patient status, or constipation and others such as male gender or higher BMI have required more studies to clearly conclude on any possible association. In many studies, simple recommendations like walking 30 min during the preparation, and additional instructions or support have also been added to instructions to improve motility and compliance.
Similar content being viewed by others
References
Connor A, Tolan D, Hughes S, Carr N, Tomson C. Consensus guidelines for the safe prescription and administration of oral bowel-cleansing agents. Gut. 2012;61:1525–32.
Ness RM, Manam R, Hoen H, Chalasani N. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol. 2001;96:1797–802.
Rex DK, Imperiale TF, Latinovich DR, Bratcher LL. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol. 2002;97:1696–700.
Bessissow T, Van Keerberghen CA, Van Oudenhove L, et al. Anxiety is associated with impaired tolerance of colonoscopy preparation in inflammatory bowel disease and controls. J Crohns Colitis. 2013;7:e580–7.
• 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. Gastroenterology. 2014;147:903–24 Guidelines suggesting that additional bowel purgatives should be considered in patients with risk factors for an inadequate preparation.
Martel M, Barkun AN, Menard C, Restellini S, Kherad O, Vanasse A. Split-dose preparations are superior to day-before bowel cleansing regimens: a meta-analysis. Gastroenterology. 2015;149:79–88.
Almadi MA, Alharbi O, Azzam N, Altayeb M, Thaniah S, Aljebreen A. Bowel preparation quality between hospitalized patients and outpatient colonoscopies. Saudi J Gastroenterol. 2018;24:93–9.
Chung YW, Han DS, Park KH, Kim KO, Park CH, Hahn T, et al. Patient factors predictive of inadequate bowel preparation using polyethylene glycol: a prospective study in Korea. J Clin Gastroenterol. 2009;43:448–52.
Yee R, Manoharan S, Hall C, Hayashi A. Optimizing bowel preparation for colonoscopy: what are the predictors of an inadequate preparation? Am J Surg. 2015;209:787–92 discussion 92.
Lukens FJ, Loeb DS, Machicao VI, Achem SR, Picco MF. Colonoscopy in octogenarians: a prospective outpatient study. Am J Gastroenterol. 2002;97:1722–5.
Cha JM, Kozarek RA, La Selva D, et al. Risks and benefits of colonoscopy in patients 90 years or older, compared with younger patients. Clin Gastroenterol Hepatol. 2016;14:80–6 e1.
Ho SC, Tai ES, Eng PH, Tan CE, Fok AC. In the absence of dietary surveillance, chitosan does not reduce plasma lipids or obesity in hypercholesterolaemic obese Asian subjects. Singap Med J. 2001;42:6–10.
Voznesenskaya TG, Solov'eva AD, Fokina NM. Psychoendocrine interrelationships in patients in a state of emotional stress during cerebral obesity. Neurosci Behav Physiol. 1989;19:408–12.
Zhang YY, Niu M, Wu ZY, Wang XY, Zhao YY, Gu J. The incidence of and risk factors for inadequate bowel preparation in elderly patients: a prospective observational study. Saudi J Gastroenterol. 2018;24:87–92.
Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc. 2011;74:885–96.
• Gandhi K, Tofani C, Sokach C, Patel D, Kastenberg D, Daskalakis C. Patient characteristics associated with quality of colonoscopy preparation: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16:357–69 e10 Recent meta-analysis that identifies a broad spectrum of patient factors associated with poor bowel preparation.
Borg BB, Gupta NK, Zuckerman GR, Banerjee B, Gyawali CP. Impact of obesity on bowel preparation for colonoscopy. Clin Gastroenterol Hepatol. 2009;7:670–5.
Lebwohl B, Wang TC, Neugut AI. Socioeconomic and other predictors of colonoscopy preparation quality. Dig Dis Sci. 2010;55:2014–20.
Yadlapati R, Johnston ER, Gregory DL, Ciolino JD, Cooper A, Keswani RN. Predictors of inadequate inpatient colonoscopy preparation and its association with hospital length of stay and costs. Dig Dis Sci. 2015;60:3482–90.
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;19:369–72.
de Wit LM, Fokkema M, van Straten A, Lamers F, Cuijpers P, Penninx BW. Depressive and anxiety disorders and the association with obesity, physical, and social activities. Depress Anxiety. 2010;27:1057–65.
Menees SB, Kim HM, Wren P, Zikmund-Fisher BJ, Elta GH, Foster S, et al. Patient compliance and suboptimal bowel preparation with split-dose bowel regimen in average-risk screening colonoscopy. Gastrointest Endosc. 2014;79:811–20.e3.
Froehlich F, Wietlisbach V, Gonvers JJ, Burnand B, Vader JP. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European panel of appropriateness of gastrointestinal endoscopy European multicenter study. Gastrointest Endosc. 2005;61:378–84.
Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27.
Nett A, Velayos F, McQuaid K. Quality bowel preparation for surveillance colonoscopy in patients with inflammatory bowel disease is a must. Gastrointest Endosc Clin N Am. 2014;24:379–92.
Bardou M, Barkun AN, Martel M. Republished: obesity and colorectal cancer. Postgrad Med J. 2013;89:519–33.
Bardou M, Barkun AN, Martel M. Obesity and colorectal cancer. Gut. 2013;62:933–47.
Chorev N, Chadad B, Segal N, Shemesh I, Mor M, Plaut S, et al. Preparation for colonoscopy in hospitalized patients. Dig Dis Sci. 2007;52:835–9.
Rotondano G, Rispo A, Bottiglieri ME, de Luca L, Lamanda R, Orsini L, et al. Quality of bowel cleansing in hospitalized patients undergoing colonoscopy: a multicentre prospective regional study. Dig Liver Dis. 2015;47:669–74.
Kotwal VS, Attar BM, Carballo MD, Lee SS, Kaura T, Go B, et al. Morning-only polyethylene glycol is noninferior but less preferred by hospitalized patients as compared with split-dose bowel preparation. J Clin Gastroenterol. 2014;48:414–8.
Bang KB, Jeong EH, Jeong WS, Chae HB, Kim NH, Lee TH, et al. Efficacy of bisacodyl given as part of a polyethylene glycol-based bowel preparation prior to colonoscopy in hospitalized patients: a prospective randomized trial. Korean J Gastroenterol. 2014;64:268–77.
Pontone S, Palma R, Panetta C, Eberspacher C, Angelini R, Pironi D, et al. Polyethylene glycol-based bowel preparation before colonoscopy for selected inpatients: a pilot study. J Dig Dis. 2018;19:40–7.
Ergen WF, Pasricha T, Hubbard FJ, Higginbotham T, Givens T, Slaughter JC, et al. Providing hospitalized patients with an educational booklet increases the quality of colonoscopy bowel preparation. Clin Gastroenterol Hepatol. 2016;14:858–64.
Rosenfeld G, Krygier D, Enns RA, Singham J, Wiesinger H, Bressler B. The impact of patient education on the quality of inpatient bowel preparation for colonoscopy. Can J Gastroenterol. 2010;24:543–6.
Lee YJ, Kim ES, Park KS, Cho KB, Jang BK, Chung WJ, et al. Education for ward nurses influences the quality of inpatient's bowel preparation for colonoscopy. Medicine (Baltimore). 2015;94:e1423.
Kushner RF, Kahan S. Introduction: the state of obesity in 2017. Med Clin North Am. 2018;102:1–11.
Fayad NF, Kahi CJ, Abd El-Jawad KH, et al. Association between body mass index and quality of split bowel preparation. Clin Gastroenterol Hepatol. 2013;11:1478–85.
Fok KC, Turner IB, Teoh WC, Levy RL. Obesity does not affect sodium picosulphate bowel preparation. Intern Med J. 2012;42:1324–9.
Sims MA, Hasler WL, Chey WD, Kim MS, Owyang C. Hyperglycemia inhibits mechanoreceptor-mediated gastrocolonic responses and colonic peristaltic reflexes in healthy humans. Gastroenterology. 1995;108:350–9.
Bytzer P, Talley NJ, Leemon M, Young LJ, Jones MP, Horowitz M. Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch Intern Med. 2001;161:1989–96.
Aring AM, Jones DE, Falko JM. Evaluation and prevention of diabetic neuropathy. Am Fam Physician. 2005;71:2123–8.
Haines ST. Treating constipation in the patient with diabetes. Diabetes Educ. 1995;21:223–32.
Taylor C, Schubert ML. Decreased efficacy of polyethylene glycol lavage solution (golytely) in the preparation of diabetic patients for outpatient colonoscopy: a prospective and blinded study. Am J Gastroenterol. 2001;96:710–4.
Hayes A, Buffum M, Hughes J. Diabetic colon preparation comparison study. Gastroenterol Nurs. 2011;34:377–82.
• 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;10:501–6 European Guidelines that do not recommend the use of models to identify patients at increased risk of inadequate cleansing, with the aim of standardizing the bowel preparation since there is insufficient evidence to determine net benefits or risks attributable to such an approach.
Anam AK, Karia K, Jesudian AB, Bosworth BP. Cirrhotic patients have worse bowel preparation at screening colonoscopy than chronic liver disease patients without cirrhosis. J Clin Exp Hepatol. 2016;6:297–302.
Salso A, De Leonardis F, Lionetti R, et al. Standard bowel cleansing is highly ineffective in cirrhotic patients undergoing screening colonoscopy. Dig Liver Dis. 2015;47:523–5.
Fang J, Fu HY, Ma D, Wang D, Liu YP, Wang YF, et al. Constipation, fiber intake and non-compliance contribute to inadequate colonoscopy bowel preparation: a prospective cohort study. J Dig Dis. 2016;17:458–63.
Athreya PJ, Owen GN, Wong SW, Douglas PR, Newstead GL. Achieving quality in colonoscopy: bowel preparation timing and colon cleanliness. ANZ J Surg. 2011;81:261–5.
Pereyra L, Cimmino D, Gonzalez Malla C, et al. Colonic preparation before colonoscopy in constipated and non-constipated patients: a randomized study. World J Gastroenterol. 2013;19:5103–10.
Lee H, Kim YH, Kim JH, Chang DK, Kim JY, Son HJ, et al. A feasibility study of probiotics pretreatment as a bowel preparation for colonoscopy in constipated patients. Dig Dis Sci. 2010;55:2344–51.
Romero RV, Mahadeva S. Factors influencing quality of bowel preparation for colonoscopy. World J Gastrointest Endosc. 2013;5:39–46.
Gimeno-Garcia AZ, Baute JL, Hernandez G, et al. Risk factors for inadequate bowel preparation: a validated predictive score. Endoscopy. 2017;49:536–43.
Committee ASoP, Saltzman JR, Cash BD, et al. Bowel preparation before colonoscopy. Gastrointest Endosc. 2015;81:781–94.
Hassan C, Bretthauer M, Kaminski MF, Polkowski M, Rembacken B, Saunders B, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2013;45:142–50.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of Interest
Alan Barkun is a consultant for Pendopharm, Boston Scientific, Olympus Canada, and Cook, and has received arms-length grant funding from Pendopharm. Myriam Martel, Charles Ménard, Sophie Restellini, Omar Kherad, Majid Almadi, and Maïté Bouchard, declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Endoscopy
Rights and permissions
About this article
Cite this article
Martel, M., Ménard, C., Restellini, S. et al. Which Patient-Related Factors Determine Optimal Bowel Preparation?. Curr Treat Options Gastro 16, 406–416 (2018). https://doi.org/10.1007/s11938-018-0208-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11938-018-0208-9