Copyright
©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2016; 8(17): 616-622
Published online Sep 16, 2016. doi: 10.4253/wjge.v8.i17.616
Predictors of suboptimal bowel preparation in asymptomatic patients undergoing average-risk screening colonoscopy
Shail M Govani, Eric E Elliott, Stacy B Menees, Stephanie L Judd, Sameer D Saini, Constantinos P Anastassiades, Annette L Urganus, Suzanna J Boyce, Philip S Schoenfeld
Shail M Govani, Eric E Elliott, Stacy B Menees, Sameer D Saini, Annette L Urganus, Philip S Schoenfeld, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
Shail M Govani, Stacy B Menees, VA Ann Arbor Healthcare System, Ann Arbor, MI 48109, United States
Eric E Elliott, Sameer D Saini, Annette L Urganus, Philip S Schoenfeld, Center for Clinical Managmenent Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48109, United States
Stephanie L Judd, Department of Internal Medicine, Wayne State University, Detroit, MI 48202, United States
Constantinos P Anastassiades, Division of Gastroenterology, Case Western Reserve University Hospital, Cleveland, OH 44106, United States
Suzanna J Boyce, Department of Internal Medicine, Duke University, Durham, NC 27708, United States
Author contributions: Govani SM and Elliott EE drafted the paper; Govani SM, Elliott EE and Menees SB analyzed the data; Govani SM, Elliott EE, Menees SB, Judd SL, Saini SD, Anastassiades CP, Urganus AL and Boyce SJ performed chart review; Schoenfeld PS conceived and designed the study; all authors approved the final paper.
Institutional review board statement: The study was reviewed and approved for publication by our institutional reviewer.
Informed consent statement: Waiver of informed consent was obtained from our institutional review board.
Conflict-of-interest statement: Dr. Schoenfeld has worked as a consultant and advisory board member for Salix Pharmaceuticals, Inc, which is the manufacturer of MoviPrep®. Other authors have no conflicts of interest.
Data sharing statement: These analyses were performed using raw data that are available only within the US Department of Veterans Affairs firewall in a secure research environment, the VA Informatics and Computing Infrastructure (VINCI). In order to comply with VA privacy and data security policies and regulatory constraints, only aggregate summary statistics and results of our analyses are permitted to be removed from the data warehouse for publication. The authors have provided detailed results of the analyses in the paper. These restrictions are in place in order to maintain patient privacy and confidentiality. Access to these data can be granted to persons who are not employees of the VA; however, there is an official protocol that must be followed for doing so. Those wishing to access the raw data that were used for this analysis may contact Shail Govani (shailg@umich.edu) to discuss the details of the VA data access approval process. The authors also confirm that an interested researcher would be able to obtain a de-identified, raw dataset upon request pending ethical approval.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shail M Govani, MD, MSc, Department of Internal Medicine, University of Michigan, 2215 Fuller Road, Room 111D, Ann Arbor, MI 48109, United States. shailg@umich.edu
Telephone: +1-734-8455865 Fax: +1-734-2322302
Received: March 20, 2016
Peer-review started: March 22, 2016
First decision: May 17, 2016
Revised: June 15, 2016
Accepted: July 11, 2016
Article in press: July 13, 2016
Published online: September 16, 2016
AIM
To identify risk factors for a suboptimal preparation among a population undergoing screening or surveillance colonoscopy.
METHODS
Retrospective review of the University of Michigan and Veteran’s Administration (VA) Hospital records from 2009 to identify patients age 50 and older who underwent screening or surveillance procedure and had resection of polyps less than 1 cm in size and no more than 2 polyps. Patients with inflammatory bowel disease or a family history of colorectal cancer were excluded. Suboptimal procedures were defined as procedure preparations categorized as fair, poor or inadequate by the endoscopist. Multivariable logistic regression was used to identify predictors of suboptimal preparation.
RESULTS
Of 4427 colonoscopies reviewed, 2401 met our inclusion criteria and were analyzed. Of our population, 16% had a suboptimal preparation. African Americans were 70% more likely to have a suboptimal preparation (95%CI: 1.2-2.4). Univariable analysis revealed that narcotic and tricyclic antidepressants (TCA) use, diabetes, prep type, site (VA vs non-VA), and presence of a gastroenterology (GI) fellow were associated with suboptimal prep quality. In a multivariable model controlling for gender, age, ethnicity, procedure site and presence of a GI fellow, diabetes [odds ratio (OR) = 2.3; 95%CI: 1.6-3.2], TCA use (OR = 2.5; 95%CI: 1.3-4.9), narcotic use (OR = 1.7; 95%CI: 1.2-2.5) and Miralax-Gatorade prep vs 4L polyethylene glycol 3350 (OR = 0.6; 95%CI: 0.4-0.9) were associated with a suboptimal prep quality.
CONCLUSION
Diabetes, narcotics use and TCA use were identified as predictors of poor preparation in screening colonoscopies while Miralax-Gatorade preps were associated with better bowel preparation.
Core tip: Suboptimal preparation quality affects the ability of endoscopists to identify polyps during colonoscopy, leading to repeated procedures or missed lesions. In this large retrospective review of screening and surveillance procedures, we found that suboptimal preparation affected 16% of the procedures. Diabetes, narcotics use and tricyclic antidepressants use were identified as predictors of poor preparation in multivariable analysis. More aggressive preparations should be considered with patients with these risk factors.
