Impact of bowel preparation type on the quality of colonoscopy: a multicenter community-based study

Abstract

Background and Objective: High-quality bowel preparation is crucial for achieving the goals of colonoscopy. However, choosing a bowel preparation in clinical practice can be a challenge because of the many formulations. This study aims to assess the impact of bowel preparation type on the quality of colonoscopy in a community setting. Methods: A retrospective, observational study was conducted utilizing a colonoscopy screening/surveillance database in central Illinois during the period of January 1, 2010 to March 31, 2014. Patients without bowel preparation assessment were excluded from this study. An ordinal logistic regression model was used to estimate the adjusted impact [odds ratio (OR)] of bowel preparation type on the quality of preparation (excellent, good, fair and poor) based on the Boston Bowel Preparation scale. The association between the time of withdrawal after insertion and the quality of preparation was also examined using a linear model. Results: The half of patients (28,386) was male. The majority (70%) of bowel preparations used polyethylene glycol (PEG), followed by sodium sulfate (21%), sodium phosphate (2%), magnesium sulfate (0.3%) and others. Compared to PEG, magnesium sulfate had a poorer quality of bowel preparations (OR=0.7, 95% CI 0.4-1.0; p<0.05), whereas the quality of bowel preparation was significantly improved by using sodium sulfate (OR=6.1, 95% CI 5.4-6.5; p<0.05), sodium phosphate (OR=2.1, 95% CI 1.8-2.5; p<0.05) and other types (OR=1.2, 95%CI 1.0-1.6; p<0.05). The rate of examination completion was higher in patients with adequate preparations as compared to those with inadequate preparations (99.4% vs 88.4%, p<0.05). Among patients with a high quality preparation, withdrawal times decreased (median time 9-11 minutes). Conclusion: When possible, sodium sulfate based preparations should be recommended in the community setting for colonoscopy because of their high quality preparation.