Endoscopy 2020; 52(S 01): S67
DOI: 10.1055/s-0040-1704207
ESGE Days 2020 oral presentations
Friday, April 24, 2020 08:30-10:30 Squeeky clean Wicklow Meeting Room 1
© Georg Thieme Verlag KG Stuttgart · New York

HOW TO IDENTIFY HOSPITALIZED PATIENTS AT HIGHER RISK OF INADEQUATE COLON CLEANSING FOR COLONOSCOPY: AN OBSERVATIONAL MULTICENTRE PROSPECTIVE STUDY AND A PREDICTIVE MODEL

L Fuccio
1   University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
,
L Frazzoni
1   University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
,
C Spada
2   Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
,
A Mussetto
3   Gastroenterology Unit, S. Maria delle Croci Hospital, Ravenna, Italy
,
C Fabbri
4   Unit of Gastroenterology and Digestive Endoscopy, Forli-Cesena Hospital, AUSL Romagna, Forlì-Cesena, Italy
,
M Manno
5   UOSD Gastroenterologia ed Endoscopia Digestiva, Azienda USL di Modena, Carpi, Italy
,
G Aragona
6   Gastroenterology and Hepatology Unit, ‘Guglielmo da Saliceto’ Hospital, Department of Internal Medicine, Piacenza, Italy
,
RM Zagari
1   University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
,
E Rondonotti
7   Gastroenterology Unit, Valduce Hospital, Como, Italy
,
G Manes
8   ASST Rhodense, Rho and Garbagnate Milanese Hospital, Department of Gastroenterology, Milan, Italy
,
P Occhipinti
9   Gastroenterology and Digestive Endoscopy Unit, Ospedale Maggiore della Carità, Novara, Italy
,
S Cadoni
10   Digestive Endoscopy Unit, Centro Traumatologico-Ortopedico Hospital, Iglesias, Italy
,
F Bazzoli
1   University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
,
C Hassan
11   Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
,
F Radaelli
7   Gastroenterology Unit, Valduce Hospital, Como, Italy
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Publikationsverlauf

Publikationsdatum:
23. April 2020 (online)

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    Aims Hospitalization is a strong predictor for inadequate colon cleansing before colonoscopy, increasing missed pathology and costs for healthcare system. We aimed to identify factors associated to inadequate colon cleansing among inpatients, and to derive and validate a predictive model.

    Tab. 1

    Predictive model including patient and preparation-related variables for inadequate bowel cleansing as derived in the derivation cohort.

    Included predictors

    OR (95%CI)

    Included predictors

    OR (95%CI)

    Bed-ridden patient

    2.02(1.44-2.83)

    Compliance to preparation (≥75% intake vs. <75%)

    0.10(0.05-0.20)

    Constipation

    1.91(1.37-2.66)

    Split-dose or same-day regimen (vs. day-before)

    0.30(0.22-0.41)

    Diabetes

    1.80(1.29-2.52)

    PEG-1L bowel prep

    0.45(0.25-0.83)

    Anti-psychotic drugs use

    3.16(1.40-7.10)

    ≥7 days of hospitalization before colonoscopy

    1.94(1.41-2.68)

    Methods Multicentre prospective observational study in 12 Italian hospitals. Consecutive adult inpatients were enrolled from February to May 2019 (derivation cohort) and from June to August 2019 (validation cohort). Inadequate cleansing was defined as BBPS< 2 in ≥1 colon segment. Multivariate logistic regression was applied.

    Results 1,524 patients underwent colonoscopy (54% male; mean age 69 ± 16 years). Adequate colon cleansing rate was 68%(n=1,032). Meetings to optimize bowel preparation(OR 0.42,CI 0.27-0.65), written and oral instructions to patients(OR 0.48,CI 0.36-0.65), admission to Gastroenterology ward(OR 0.71,CI 0.51-0.98), split-dose regimen(OR 0.27,CI 0.20-0.35), the administration of a 1-Litre polyethylene glycol-based bowel purge(OR 0.39,CI 0.23-0.65), and≥75% intake of bowel preparation(OR 0.09,CI 0.05-0.15) were protective factors against inadequate colon cleansing, whereas bed-ridden status(OR 2.14,CI 1.55- 2.98), constipation(OR 2.16,CI 1.55-3), diabetes mellitus(OR 1.61,CI 1.18-2.20), anti-psychotic drugs use(OR 3.26,CI 1.62-6.56), ≥7 days of hospitalization(OR 1.02,CI 1.00-1.04) were risk factors for inadequate colon cleansing.

    A predictive model (see [Table]) was derived in derivation cohort (n=1,016) and validated in validation cohort (n=508), showing good calibration (p=0.317 and p=0.638) and discrimination

    (accuracy 80%,CI 77-83%; 78%,CI 74-82%) in both cohorts. An app was developed.

    Conclusions Our study is the first to identify setting-, patient- and preparation-related factors influencing colon cleansing among inpatients. We derived and validated a predictive model for clinicians.


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