Influencing factors for the quality of bowel preparation with polyethylene glycol electrolyte powder combined with diet control before colonoscopy in children
JIAO Feng-Fei, LIU Zhi-Feng, SHEN Yan-Chi, CAO Jin-Jin, GAO Yuan, WANG Hui, TANG Wei-Ting, HUANG Yan
Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
Abstract Objective To investigate the influencing factors for the quality of bowel preparation before colonoscopy in children and the association of the interval from the last administration of laxative to the start of colonoscopy (shortly referred to as waiting time) with the quality of bowel preparation. Methods A retrospective analysis was performed for the children who were admitted to the Department of Gastroenterology, Children's Hospital of Nanjing Medical University, from January to November 2020, and received bowel preparation with polyethylene glycol electrolyte powder combined with diet control before colonoscopy. According to the score of Boston bowel preparation scale, they were divided into two groups: adequate bowel preparation group (n=337) and inadequate bowel preparation group (n=30). Related data were collected from the children in both groups, including general information, possible influencing factors for the quality of bowel preparation, adverse reactions associated with bowel preparation, duration of colonoscopy, and postoperative diagnosis. Univariate and multivariate analyses were used to explore the influencing factors for the quality of bowel preparation. Results The univariate analysis showed that age, body weight, and waiting time were associated with inadequate bowel preparation (P<0.05). The multivariate analysis showed that older age (OR=2.155, 95%CI: 1.087-4.273, P=0.028) and longer waiting time (OR=1.559, 95% CI: 1.191-2.041, P=0.001) were independent risk factors for inadequate bowel preparation. The receiver operating characteristic (ROC) curve analysis showed that the cut-off value of waiting time was 5.5 hours in determining whether bowel preparation was adequate or not, with a sensitivity of 90.0%, a specificity of 50.7%, and an area under the ROC curve of 0.708. After grouping based on waiting time, it was found that the incidence rate of inadequate bowel preparation in the ≥5.5 hours group was significantly higher than that in the <5.5 hours group [14.0% (27/193) vs 1.7% (3/174), P<0.001]. Conclusions For children who use polyethylene glycol electrolyte powder combined with diet control for bowel preparation, older age is an independent risk factor for inadequate bowel preparation before colonoscopy, which may be associated with an insufficient dose of polyethylene glycol in older children. Longer waiting time is also an independent risk factor for inadequate bowel preparation, and it is recommended that the waiting time should not exceed 5.5 hours.
JIAO Feng-Fei,LIU Zhi-Feng,SHEN Yan-Chi et al. Influencing factors for the quality of bowel preparation with polyethylene glycol electrolyte powder combined with diet control before colonoscopy in children[J]. CJCP, 2022, 24(4): 366-371.
JIAO Feng-Fei,LIU Zhi-Feng,SHEN Yan-Chi et al. Influencing factors for the quality of bowel preparation with polyethylene glycol electrolyte powder combined with diet control before colonoscopy in children[J]. CJCP, 2022, 24(4): 366-371.
Yadlapati R, Johnston ER, Gregory DL, et al. Predictors of inadequate inpatient colonoscopy preparation and its association with hospital length of stay and costs[J]. Dig Dis Sci, 2015, 60(11): 3482-3490. PMID: 26093612. DOI: 10.1007/s10620-015-3761-2.
Seo EH, Kim TO, Park MJ, et al. Optimal preparation-to-colonoscopy interval in split-dose PEG bowel preparation determines satisfactory bowel preparation quality: an observational prospective study[J]. Gastrointest Endosc, 2012, 75(3): 583-590. PMID: 22177570. DOI: 10.1016/j.gie.2011.09.029.
Kim HG, Jeon SR, Kim MY, et al. How to predict adequate bowel preparation before colonoscopy using conventional polyethylene glycol: prospective observational study based on survey[J]. Dig Endosc, 2015, 27(1): 87-94. PMID: 24833415. DOI: 10.1111/den.12312.
Guerrant RL, Van Gilder T, Steiner TS, et al. Practice guidelines for the management of infectious diarrhea[J]. Clin Infect Dis, 2001, 32(3): 331-351. PMID: 11170940. DOI: 10.1086/318514.
Nguyen DL, Wieland M. Risk factors predictive of poor quality preparation during average risk colonoscopy screening: the importance of health literacy[J]. J Gastrointestin Liver Dis, 2010, 19(4): 369-372. PMID: 21188326.
Chan WK, Saravanan A, Manikam J, et al. Appointment waiting times and education level influence the quality of bowel preparation in adult patients undergoing colonoscopy[J]. BMC Gastroenterol, 2011, 11: 86. PMID: 21798022. PMCID: PMC3156748. DOI: 10.1186/1471-230X-11-86.
Reddy P, Mencin A, Lebwohl B. Risk factors for suboptimal bowel preparation for colonoscopy in pediatric patients[J]. J Pediatr Gastroenterol Nutr, 2021, 73(1): e1-e6. PMID: 33661246. DOI: 10.1097/MPG.0000000000003114.
Papastergiou V, Papasavvas S, Mathou N, et al. A delayed onset of bowel activity after the start of conventional polyethylene glycol predicts inadequate colon cleansing before colonoscopy: a prospective observational study[J]. United European Gastroenterol J, 2016, 4(2): 199-206. PMID: 27087947. PMCID: PMC4804377. DOI: 10.1177/2050640615608572.
Eun CS, Han DS, Hyun YS, et al. The timing of bowel preparation is more important than the timing of colonoscopy in determining the quality of bowel cleansing[J]. Dig Dis Sci, 2011, 56(2): 539-544. PMID: 21042853. DOI: 10.1007/s10620-010-1457-1.
20 Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration[J]. Anesthesiology, 2017, 126(3): 376-393. PMID: 28045707. DOI: 10.1097/ALN.0000000000001452.
Johnson DA, Barkun AN, Cohen LB, et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer[J]. Gastroenterology, 2014, 147(4): 903-924. PMID: 25239068. DOI: 10.1053/j.gastro.2014.07.002.