In the Journals

Inpatient bowel prep can improve with a few modifiable factors

Ari Garber
Ari Garber

Making a few adjustments can help reduce inadequate bowel preparation in an inpatient setting while potentially reducing morbidity and costs, according to research published in the Journal of Hospital Medicine.

Ari Garber, MD, of the department of gastroenterology, hepatology and nutrition at Cleveland Clinic, told Healio Gastroenterology and Liver Disease that adequate bowel prep is crucial not only to identifying a problem and providing intervention but also to preventing additional complications.

“Poor bowel preparation reduces the likelihood of identifying possible lesions, the very reason we perform the inpatient colonoscopy in the first place and places the patient at increased risk when manipulating the colonoscope with inadequate visualization,” he said in an interview. “Consequences of inadequate bowel preparation have downstream effects as well including canceled and repeat procedures, increased procedural time and possible adverse events related to poor visualization including but not limited to trauma to the large intestines.”

Garber and colleagues wanted to explore bowel preparation in hospitalized patients, which has been studied less extensively than in outpatients. While outpatients have time to prepare for screening or surveillance, inpatients who need to undergo colonoscopy have a number of complications that can get in the way of having the best bowel preparation possible.

“Patients admitted to the hospital may have symptoms or illnesses that make consumption of the bowel prep more difficult. This includes nausea, vomiting, dysphagia and gastroparesis,” Garber said.

Researchers analyzed data from adult inpatients who underwent colonoscopy between 2011 and 2017 to identify modifiable factors associated with inadequate bowel preparation.

Of 8,819 patients included in the analysis, researchers found that 51% had inadequate bowel preparation.

Investigators were able to identify opiate use within 3 days of colonoscopy (OR = 1.31; 95% CI, 1.18–1.45), colonoscopy performed after noon (OR = 1.25; 95% CI, 1.1–1.41) and solid diet the day before colonoscopy (OR = 1.37; 95% CI, 1.18–1.59) as modifiable factors linked with inadequate bowel preparation. If patients were able to avoid opiates, undergo colonoscopy before noon and have either a clear liquid diet or not eat the day before a procedure, researchers found that inadequate bowel prep rates could be reduced by 5.6%.

While Garber admitted this reduction might seem insubstantial, he said it could have a significant influence on big-picture outcomes. Considering the number of inpatient colonoscopies nationwide, Garber said identifying lesions that would have otherwise been missed due to an inadequately prepared colon could have a substantial impact on comorbidities. It also offers the potential to reduce the number of repeat procedures that could reduce health care costs.

“This is not a minor issue, this is a huge issue,” Garber said. “You nearly flip a coin to determine who is going to have adequate vs. inadequate bowel preparation. This has significant ramifications for follow-up and follow through in the inpatient setting. Patients with inadequate bowel preparation are going to have a longer length of stay, which has a downstream effect of increased costs on the health care system.” by Alex Young

Disclosures: Garber reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.

Editor's note: This article was edited on April 22, 2019, to include additional quotes from Garber.

Ari Garber
Ari Garber

Making a few adjustments can help reduce inadequate bowel preparation in an inpatient setting while potentially reducing morbidity and costs, according to research published in the Journal of Hospital Medicine.

Ari Garber, MD, of the department of gastroenterology, hepatology and nutrition at Cleveland Clinic, told Healio Gastroenterology and Liver Disease that adequate bowel prep is crucial not only to identifying a problem and providing intervention but also to preventing additional complications.

“Poor bowel preparation reduces the likelihood of identifying possible lesions, the very reason we perform the inpatient colonoscopy in the first place and places the patient at increased risk when manipulating the colonoscope with inadequate visualization,” he said in an interview. “Consequences of inadequate bowel preparation have downstream effects as well including canceled and repeat procedures, increased procedural time and possible adverse events related to poor visualization including but not limited to trauma to the large intestines.”

Garber and colleagues wanted to explore bowel preparation in hospitalized patients, which has been studied less extensively than in outpatients. While outpatients have time to prepare for screening or surveillance, inpatients who need to undergo colonoscopy have a number of complications that can get in the way of having the best bowel preparation possible.

“Patients admitted to the hospital may have symptoms or illnesses that make consumption of the bowel prep more difficult. This includes nausea, vomiting, dysphagia and gastroparesis,” Garber said.

Researchers analyzed data from adult inpatients who underwent colonoscopy between 2011 and 2017 to identify modifiable factors associated with inadequate bowel preparation.

Of 8,819 patients included in the analysis, researchers found that 51% had inadequate bowel preparation.

Investigators were able to identify opiate use within 3 days of colonoscopy (OR = 1.31; 95% CI, 1.18–1.45), colonoscopy performed after noon (OR = 1.25; 95% CI, 1.1–1.41) and solid diet the day before colonoscopy (OR = 1.37; 95% CI, 1.18–1.59) as modifiable factors linked with inadequate bowel preparation. If patients were able to avoid opiates, undergo colonoscopy before noon and have either a clear liquid diet or not eat the day before a procedure, researchers found that inadequate bowel prep rates could be reduced by 5.6%.

While Garber admitted this reduction might seem insubstantial, he said it could have a significant influence on big-picture outcomes. Considering the number of inpatient colonoscopies nationwide, Garber said identifying lesions that would have otherwise been missed due to an inadequately prepared colon could have a substantial impact on comorbidities. It also offers the potential to reduce the number of repeat procedures that could reduce health care costs.

“This is not a minor issue, this is a huge issue,” Garber said. “You nearly flip a coin to determine who is going to have adequate vs. inadequate bowel preparation. This has significant ramifications for follow-up and follow through in the inpatient setting. Patients with inadequate bowel preparation are going to have a longer length of stay, which has a downstream effect of increased costs on the health care system.” by Alex Young

Disclosures: Garber reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.

Editor's note: This article was edited on April 22, 2019, to include additional quotes from Garber.