Department of Internal Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, USA.
Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, 5841 South Maryland Avenue, Chicago, IL, MC4076, USA.
Dig Dis Sci. 2022 Jul;67(7):3185-3191. doi: 10.1007/s10620-021-07274-x. Epub 2021 Oct 17.
Effective colon cancer screening requires adequate bowel preparation. Anecdotal evidence has suggested that patients with a history of bariatric surgery are more likely to have inadequate preparation. This study aims to evaluate the role of bariatric surgery as a predictive risk factor for inadequate bowel preparation.
Data were collected retrospectively for consecutive colonoscopies between March 1, 2013, and November 15, 2017. Only the index colonoscopy for each patient within the review period, and those scored using the Boston Bowel Preparation Scale (BBPS) were included. Inadequate preparation was defined as any one or more colon segments with a BBPS score of less than two, and patients with a history of bariatric surgery were identified using ICD 9/10 codes. Multivariate logistic regression and propensity score matching was used to assess for independent factors predictive of inadequate bowel preparation.
A total of 25,318 colonoscopies were included in the analysis. Two hundred 278 (1.1%) patients had a history of bariatric surgery, among which 171 (61.5%) had a history of bypass surgery and 107 (38.5%) had a history of restrictive surgical procedure. A history of bariatric surgery was predictive of inadequate bowel preparation in both univariate (OR: 2.87, 95% CI: 1.92-4.29, P = 0.0003) and multivariate analysis (OR: 2.16, 95% CI: 1.43-3.27, P = 0.0003) after controlling for differences in baseline characteristics. When evaluated separately, a history of bypass surgery was associated with inadequate bowel preparation (aOR: 2.96, 95% CI: 1.86-4.72, P < 0.0001), whereas a history of a restrictive bariatric surgery was not associated with inadequate bowel preparation in multivariate analysis (aOR: 0.98, 95% CI: 0.4-2.45, P = 0.971).
A history of bariatric surgery is an independent risk factor for inadequate bowel preparation. Furthermore, bypass bariatric surgeries had higher rates of inadequate preparation when compared to restrictive bariatric surgeries. Further quality improvement initiatives should be directed at identifying the appropriate bowel preparation regimen in this population.
有效的结肠癌筛查需要充分的肠道准备。有传闻证据表明，接受过减肥手术的患者更有可能准备不充分。本研究旨在评估减肥手术作为预测肠道准备不充分的风险因素的作用。
数据是在 2013 年 3 月 1 日至 2017 年 11 月 15 日期间回顾性收集的连续结肠镜检查数据。仅纳入每个患者的首次结肠镜检查，并且仅纳入使用波士顿肠道准备量表（BBPS）评分的结肠镜检查。肠道准备不充分定义为任何一个或多个结肠段的 BBPS 评分小于 2，并且使用 ICD-9/10 代码识别有减肥手术史的患者。使用多变量逻辑回归和倾向评分匹配来评估预测肠道准备不充分的独立因素。
共纳入 25318 例结肠镜检查。20278 例（1.1%）患者有减肥手术史，其中 171 例（61.5%）有旁路手术史，107 例（38.5%）有限制性手术史。减肥手术史与肠道准备不充分在单变量（OR：2.87，95%CI：1.92-4.29，P=0.0003）和多变量分析（OR：2.16，95%CI：1.43-3.27，P=0.0003）中均具有预测价值，同时控制了基线特征的差异。单独评估时，旁路手术史与肠道准备不充分相关（aOR：2.96，95%CI：1.86-4.72，P<0.0001），而在多变量分析中，限制性减肥手术史与肠道准备不充分无关（aOR：0.98，95%CI：0.4-2.45，P=0.971）。
减肥手术史是肠道准备不充分的独立危险因素。此外，与限制性减肥手术相比，旁路减肥手术的准备不充分率更高。应进一步开展质量改进措施，以确定该人群的适当肠道准备方案。
