March 20, 2020
2 min read

Model identifies risk for inadequate bowel cleansing in hospitalized patients

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Researchers identified factors associated with inadequate bowel cleansing and used it to develop an app for clinicians to find which patients might have inadequate colonoscopy preparation, according to research published in Clinical Gastroenterology and Hepatology.

Lorenzo Fuccio, MD, of the gastroenterology unit at S. Orsola-Malpighi Hospital in Bologna, Italy, and colleagues wrote that inadequate inpatient bowel prep can increase a patient’s length of stay in the hospital and increase costs by about 30%.

“The identification of both modifiable and non-modifiable predictive factors of inadequate bowel preparation would have several implications at patient’s and health care system’s level,” they wrote. “Improving the quality of bowel cleansing would reduce the need of repeating the procedure and the risk of missing lesions. Furthermore, it would reduce the burden for [the] health care system, avoiding overloading the endoscopy units and decreasing the hospital stay, thus reducing costs.”

Researchers conducted a prospective observational study at 12 Italian hospitals to identify which factors are associated with adequate and inadequate bowel cleansing. They enrolled consecutive patients scheduled for colonoscopy into derivation (n = 1,016) and validation (n = 508) cohorts.

In the combined cohorts, 1,032 patients had inadequate bowel cleansing (68%), defined as a Boston bowel prep scale score below 2 in any colon segment.

Fuccio and colleagues found that physicians’ meetings to optimize bowel preparation (OR = 0.42; 95% CI, 0.27–0.65), written and oral instructions to patients (OR, 0.48; 95% CI, 0.36–0.65), admission to gastroenterology unit (OR = 0.71; 95% CI, 0.51–0.98), split-dose regimens (OR = 0.27; 95% CI, 0.2–0.35), a 1-liter polyethylene glycol-based bowel purge (OR = 0.39; 95% CI, 0.23-0.65), and 75% or more intake of bowel preparation (OR = 0.09; 95% CI, 0.05–0.15) were all factors associated with reduced odds of inadequate colon cleansing.

Additionally, they found that bed-ridden status (OR = 2.14; 95% CI, 1.55–2.98), constipation (OR = 2.16; 95% CI, 1.55–3.0), diabetes (OR = 1.61; 95% CI, 1.18–2.2), use of anti-psychotic drugs (OR = 3.26; 95% CI, 1.62–6.56), and 7 or more days of hospitalization (OR = 1.02; 95% CI, 1– 1.04) were associated with increased risk for inadequate colon cleansing.

Investigators used these factors to develop an app that uses a model to identify patients with inadequate cleansing.

“The prediction of the adequacy of colon cleansing before colonoscopy may promote the adoption of corrective measures, such as the systematic introduction of dose-splitting or more aggressive, mixed preparations in patients with several risk factors,” Fuccio and colleagues wrote. “We provided an easy-to-use app that can be useful for clinicians to instantly find the probability of adequate colon cleansing ‘tailored’ to the patient.”

Disclosure: The authors report no relevant financial disclosures.