Patients with History of Colonoscopy Are Less Likely to Achieve High Quality Preparation After Implementing Split-Dose Bowel Preparation.

Mar 22, 2018Acta gastro-enterologica Belgica

Patients with Previous Colonoscopy Are Less Likely to Have Good Bowel Cleaning Using Split-Dose Preparation

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Abstract

60% of colonoscopies had excellent bowel preparation quality among 1478 patients studied.

Patients undergoing surveillance colonoscopies were less likely to achieve excellent bowel preparation compared to those in the non-surveillance group.
The odds of achieving excellent bowel preparation were significantly lower for patients with prior colonoscopies (OR 0.8).
Adequate bowel preparation was also less common in the surveillance group (OR 0.8).
Educational interventions may be necessary to improve compliance with split-dose bowel preparation among patients with a history of colonoscopy.

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BACKGROUND: Anecdotally, we observed that patients who had previous colonoscopies were less likely to follow newly implemented split-dose bowel preparation (SDBP) instructions. We investigated whether the indication for colonoscopy is an independent factor for achieving high quality bowel preparation among patients asked to follow SDBP.

METHODS: We performed a retrospective study of data from 1478 patients who received outpatient colonoscopies in 2014 (the year of SDBP implementation) at our Veterans Affairs Medical Center. We collected information related to demographics and factors known to affect bowel preparations. Reasons for colonoscopy were dichotomized into surveillance (previous colonoscopy) vs. non-surveillance (positive occult blood test or screening). Bowel preparation quality was scored using the Boston Bowel Preparation Scale (BBPS), and was categorized as either excellent vs. not excellent (BBPS≥7 vs. BBPS<7), or adequate vs. inadequate (BBPS≥6 vs. BBPS<6).

RESULTS: Bowel preparation quality was excellent in 60% of colonoscopies and adequate in 84% of colonoscopies. Thirty-six percent (535) were surveillance colonoscopies. In multivariate logistic regression analysis, more patients in the non-surveillance group achieved excellent (OR 0.8 ; 95% CI [0.7-0.8], P <0.0001) and adequate (OR 0.8 ; 95% CI [0.7-0.9], P <0.006) bowel preparation than did patients in the surveillance group.

CONCLUSION: Patients with a prior colonoscopy might not follow the split-dose bowel preparation instructions. Educational interventions emphasizing the benefits of SDBP in this group of patients may help ensure compliance and prevent the habitual use of day-before preparations.

Patients with History of Colonoscopy Are Less Likely to Achieve High Quality Preparation After Implementing Split-Dose Bowel Preparation.

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