Investigators have developed an app that may aide clinicians in identifying hospitalized patients who may have inadequate colon cleansing prior to undergoing a colonoscopy, according to a study published in Clinical Gastroenterology and Hepatology.
The app was designed based on results from an observational study that was conducted at 12 hospitals in Italy. Adult inpatients who were scheduled for colonoscopy were assessed for bowel cleansing using the Boston bowel preparation scale. The derivation cohort included 1016 individuals and the validation cohort had 508; all colonoscopies were performed in 2019.
Most participants (68%) were found to have adequate cleansing. Several factors reduced the likelihood of inadequate cleansing, including written and oral instructions to the patient (odds ratio [OR], 0.48; 95% CI, 0.36-0.65), 1-liter polyethylene glycol-based bowed purge (OR, 0.39; 95% CI, 0.23-0.65), a split-dose regimen (OR, 0.27; 95% CI, 0.20-0.35), and ≤75% intake of bowel preparation (OR, 0.09; 95% CI, 0.05-0.15).
The investigators reported several factors that increased the odds of an inadequate colon cleanse, including the use of antipsychotic drugs (OR, 3.26; 95% CI, 1.62-6.56), constipation (OR, 2.16; 95% CI, 1.55-3.00), bed-ridden status (OR, 2.14; 95% CI, 1.55-2.98), diabetes mellitus (OR, 1.61; 95% CI, 1.18-2.20), and hospital duration of ≥1 week (OR, 1.02; 95% CI, 1.00-1.04).
The researchers developed a model based on the first cohort and tested it on the validation cohort. They reported that their model had a discrimination value based on a c-statistic of 0.78 (95% CI, 0.74-0.81; P =.232).
A limitation of this study is that it was not designed to compare various colon-cleansing methods, and for this reason the method of colon cleanse was not well balanced in the study (eg, 4-L preparation [n=717], 2-L preparation [n=624], and 1-L preparation [n=183]).
The study authors concluded that they identified patient- and preparation-related factors that affect colon cleansing for inpatients. The model that they derived from these data is available for use in their app.
Fuccio L, Frazzoni L, Spada C, et al. Factors that affect adequacy of colon cleansing for colonoscopy in hospitalized patients [published online March 18, 2020]. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2020.02.055