Quality: Predictive Models of Inadequate Colonic Preparation
Study Details
Study Description
Brief Summary
The main purpose of the study is to evaluate in a prospective cohort of patients with an appointment for the performance of an outpatient colonoscopy the prediction of the quality of colonic cleansing through the use of 3 predictive models.
The colon cleansing quality will be assessed by a validated scale (Boston Bowel Preparation Scale, BBPS). Patients will be prepared with polyethylene glycol (PEG), PEG plus ascorbic acid (PEG-Asc) or sodium picosulfate-oxide magnesium solution (PS).
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Detailed Description
Although, current guidelines recommend a rate of inadequate bowel cleansing for colonoscopy not higher than 10-15%, in clinical practice poor bowel cleansing in endoscopy units ranged between 6.8% and 33%. The determinants of poor cleanliness have been evaluated in different studies and can be classified into patient-dependent predictors, which include demographic, socioeconomic and clinical variables, variables dependent on the preparation protocol, including the assigned diet, the type of preparation, its fractionation and the space of time elapsed between the last intake and the colonoscopy, and the tolerance mainly attributed to the volume and taste of the evacuating preparation The American Association of Gastrointestinal Endoscopy recommends the administration of additional preparation to these patients with a higher probability of inadequate preparation. Once non-compliance and lack of tolerance to cleaning protocols are excluded, the reason for inadequate preparation is usually the lack of effectiveness of the cleaning protocol. Therefore, it is advisable to select patients who can benefit from supplemented cleaning preparation or intensified cleaning protocols.
There are so far 4 published predictive models that incorporate clinical variables with the aim of determining patients who are candidates for intensified preparations. Of the models mentioned in the previous studies, only 3 are clearly detailed in the corresponding articles.
The researchers will offer to participate in the study to patients scheduled for a colonoscopy who meet all the inclusion criteria and none of the exclusion criteria. The researchers will explain the purpose of the study and will ask to sign the informed consent. They will give verbal and written information.
Subsequently, the colonoscopy will be performed and the cleaning quality will be scored according to the BBPS considering suboptimal a cleaning quality of less than 2 points in a segment of the colon.
The bowel cleansing quality following BBPS will be assessed by the endoscopist
Study Design
Outcome Measures
Primary Outcome Measures
- Quality of bowel cleansing assessed by the Boston Bowel Preparation Scale [3 months]
Quality of bowel cleansing assessed by the Boston Bowel Preparation Scale. This scale goes from 0 (no preparation) to 3 points (excellent preparation) in the three segments of the colon (proximal, transverse and distal). The maximum score is 9 points
Secondary Outcome Measures
- Predictive factors of poor bowel cleansing [3 months]
To evaluate the factors associated with inadequate colonic cleaning in this cohort of patients with the aim of improving the models described above
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age >18
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To sign the informed consent,
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Patients with indication of outpatient colonoscopy
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Patients ingesting preparation
Exclusion Criteria:
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Resection of more than one colon segment.
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Ileus, intestinal obstruction, megacolon.
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Poorly controlled hypertension (HTAS> 180 HTAD> 100).
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Terminal renal failure (pre-dialysis or dialysis).
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Congestive heart failure (NYHA III-IV).
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Acute liver failure.
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Severe psychiatric illness.
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Dementia with difficulty in the intake of the preparation.
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Pregnancy or breastfeeding.
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Refusal to participate in the study.
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Allergies.
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Incomplete colonoscopy except for poor bowel cleansing
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Manuel Hernandez-Guerra, MD
Investigators
- Principal Investigator: Antonio Z Gimeno García, MD, PhD, Hospital Universitario de Canarias
Study Documents (Full-Text)
None provided.More Information
Publications
- CHUC_2022_87