A meta-analysis of 154 studies involving 358,257 patients identified 48 risk factors associated with inadequate bowel preparation for colonoscopy.
The study, published in The American Journal of Gastroenterology, found Medicaid insurance status showed an odds ratio of 2.07, while brown liquid rectal effluent had an odds ratio of 4.71.
The researchers analyzed data focusing on adjusted risk factors across four categories: sociodemographic, comorbidity-related, medication-related, and preparation/procedure-related factors.
Complete List of Risk Factors Identified
The analysis revealed 11 sociodemographic factors: Medicaid insurance, current tobacco use, Black race, low education level, male sex, unmarried status, age (both as a continuous variable and ≥ 65 years), BMI (including obesity and overweight categories), low income, and White race.
Researchers identified 19 comorbidity-related factors: psychiatric disease, liver cirrhosis, ASA class of 3 or more, poor functional status, constipation, diabetes mellitus, previous abdominopelvic surgery, hematochezia, congestive heart failure, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, hypertension, inflammatory bowel disease, diarrhea, dementia, stroke, anemia, and previous gynecologic surgery.
The study found six medication-related factors: tricyclic antidepressants, antidepressants, opioid use, non-TCAs, calcium channel blockers, and polypharmacy.
The team found 12 preparation/procedure-related factors: brown liquid rectal effluent, incomplete bowel preparation intake, lack of split-dose preparation, increased BP-to-defecation interval, nonadherence to dietary instructions, increased BP-to-colonoscopy interval, BP intolerance, previous inadequate preparation, inpatient status, afternoon colonoscopy, low-volume BP regimen, and surveillance colonoscopy.
Key Statistical Findings
For medications, tricyclic antidepressants showed an odds ratio of 2.41. The analysis found significant associations with opioids and calcium channel blockers as well. Incomplete bowel preparation intake had an odds ratio of 3.27, while lack of split-dose preparation showed 2.67. Afternoon colonoscopy timing showed no significant association in prospective studies.
Study Details
The researchers analyzed studies from Asia (65 studies), North America (49 studies), Europe (35 studies), and other regions. They noted limitations including heterogeneity in 41 risk factors and varying definitions across studies.
The research team included investigators from Indiana University School of Medicine, Ascension Saint Francis Hospital, and Mayo Clinic. Potential competing interests are outlined in the study.
