Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba.
School of Pharmacy.
J Clin Gastroenterol. 2020 Sep;54(8):707-713. doi: 10.1097/MCG.0000000000001286.
Quality of bowel preparation is an important factor influencing adenoma detection. Patient education is believed to improve the quality of bowel preparation but might be resource-intensive. We aimed to (a) identify risk factors for failed bowel preparations and (b) develop and test the efficacy of a screening tool that allows to prospectively identify and target patients at increased risk.
Part 1: 76 consecutive outpatients with poor bowel preparation were compared with 76 age-matched and gender-matched outpatients with good preparation from the same procedure lists. Sociodemographic and clinical data were obtained from centralized databases. Univariate analysis and multivariate logistic regression was used to identify risk factors for poor bowel preparation. Part 2: on the basis of results of part 1, a screening tool for prospectively identifying patients at high risk was developed, and targeted education tested.
We identified the use of opioids or other constipating agents and low socioeconomic status as risk factors for poor bowel preparation [odds ratio (OR)=2.88; 95% confidence interval (CI): 1.22-6.80 and OR=2.43; 95% CI: 1.25-4.72]. Diabetes, hypothyroidism, age, and gender were found to have no effect on quality. When education was provided only to patients at increased risk, the targeted approach did not negatively affect the proportion of poor preparation (OR=6.12%; 95% CI: 4.79%-7.78% vs. OR=5.73%; 95% CI: 4.61%-7.10%).
Poor bowel preparation is associated with specific risk factors. Identifying and specifically targeting education at patients with these risk factors appears to facilitate more efficient use of education resources in endoscopy.
肠道准备的质量是影响腺瘤检出率的一个重要因素。人们认为患者教育可以改善肠道准备的质量，但可能需要大量的资源。我们旨在：（a）确定肠道准备失败的危险因素；（b）开发并测试一种筛查工具，以便能够前瞻性地识别和针对高风险患者。
第 1 部分：76 例肠道准备不良的连续门诊患者与来自同一程序列表的 76 例年龄和性别匹配的肠道准备良好的门诊患者进行比较。从集中的数据库中获得社会人口统计学和临床数据。使用单变量分析和多变量逻辑回归来识别肠道准备不良的危险因素。第 2 部分：基于第 1 部分的结果，开发了一种用于前瞻性识别高风险患者的筛查工具，并对目标教育进行了测试。
我们确定使用阿片类药物或其他致便秘药物和低社会经济地位是肠道准备不良的危险因素[比值比（OR）=2.88；95%置信区间（CI）：1.22-6.80 和 OR=2.43；95% CI：1.25-4.72]。糖尿病、甲状腺功能减退、年龄和性别对质量没有影响。当仅向高风险患者提供教育时，靶向方法不会对不良准备的比例产生负面影响（OR=6.12%；95% CI：4.79%-7.78%比 OR=5.73%；95% CI：4.61%-7.10%）。
肠道准备不良与特定的危险因素有关。确定并专门针对具有这些危险因素的患者进行教育，似乎可以更有效地利用内镜检查中的教育资源。
