Elsevier

Gastrointestinal Endoscopy

Volume 71, Issue 7, June 2010, Pages 1244-1252.e2
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Patients' description of rectal effluent and quality of bowel preparation at colonoscopy

https://doi.org/10.1016/j.gie.2009.11.053Get rights and content

Background

There are few data evaluating how accurately patients can predict the quality of their colonoscopy preparation.

Objective

The aim of this study was to assess whether patients' description of rectal effluent predicts preparation quality as assessed per endoscopist.

Design

Prospective, cross-sectional.

Setting

Three outpatient endoscopy units at Indiana University Medical Center.

Patients

Patients undergoing colonoscopy were enrolled.

Interventions

Patients were given a questionnaire assessing their preparation based on the description of their last rectal effluent. This was compared with endoscopists assessment of preparation.

Main Outcome Measurements

Correlation between the patient's description of the last effluent and endoscopist's assessment of preparation.

Results

Of the total 429 patients, 59% were male and 75% were white. There was only slight agreement between the patients' description of effluent and the endoscopists' description of preparation (Cohen kappa statistic, 0.067). However, patients reporting brown liquid or solid had a 54% chance of having fair or poor preparation. Ingestion of <90% of the preparation, male gender, use of medications associated with constipation, and comorbid conditions were independent predictors of fair or poor preparation.

Limitations

No validated system to assess the quality of the bowel preparation or for patients to assess their preparation.

Conclusion

Patients' description of last rectal effluent is not a reliable predictor of quality of preparation per the endoscopist, but patients reporting their last effluent as brown liquid or solid have a substantial likelihood of inadequate preparation. These patients may benefit from additional preparation, which may be particularly useful if it can be administered in the endoscopy unit followed by colonoscopy on the same day.

Section snippets

Materials and methods

The study was approved by the Institutional Review Board at Indiana University/Clarian Health Partners.

The study was prospective and was conducted in 3 hospitals at Indiana University Medical Center: Indiana University Hospital (UH), Wishard Memorial Hospital (a county hospital [CH]), and Roudebush Veterans Administration Hospital (VAH). Endoscopy units in the 3 locations are each open access. The UH serves primarily private patients, the CH serves the indigent population in Indianapolis,

Patient characteristics and general data

A total of 429 patients were interviewed in 3 hospitals, 221 at UH, 105 at CH, and 103 at VAH. Of these, 255 (59%) were male. Seventy-five percent were white, 24% were black, 4 were Asian, and 1 was Puerto Rican. Table 1 shows demographics, preparations used, compliance with preparation, comorbidities, and use of medications associated with constipation. The populations at the 3 hospitals were different regarding many of these factors (Table 1). Patients at UH had received more education, had

Discussion

In this report we describe a prospective assessment of colonoscopy patients regarding whether their description of the last rectal effluent predicted quality of bowel preparation as assessed by endoscopists. We found poor correlations between patients' final effluent descriptions, but patients who reported brown liquid or brown solid in their last effluent had a high (54%) risk of fair or poor preparation as judged by the endoscopist. Such patients may be candidates for additional laxative or

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    Citation Excerpt :

    Before the examination and administration of sedation, patients should be queried about their compliance with the preparation and the quality of their effluent. Patients with persistent brown effluent should be considered for large-volume enemas or additional oral preparation before proceeding with colonoscopy.135 Patients with an inadequate colon preparation usually require a repeat examination with a more thorough attempt at colonic cleansing.136

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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