Afecto Edgar, Ponte Ana, Fernandes Sónia, Gomes Catarina, Correia João Paulo, Carvalho João
Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
GE Port J Gastroenterol. 2021 Dec 21;30(2):134-140. doi: 10.1159/000520905. eCollection 2023 Mar.
Bowel preparation is a major quality criterion for colonoscopies. Models developed to identify patients with inadequate preparation have not been validated in external cohorts. We aim to validate these models and determine their applicability.
Colonoscopies between April and November 2019 were retrospectively included. Boston Bowel Preparation Scale ≥2 per segment was considered adequate. Insufficient data, incomplete colonoscopies, and total colectomies were excluded. Two models were tested: model 1 (tricyclic antidepressants, opioids, diabetes, constipation, abdominal surgery, previous inadequate preparation, inpatient status, and American Society of Anesthesiology [ASA] score ≥3); model 2 (co-morbidities, tricyclic antidepressants, constipation, and abdominal surgery).
We included 514 patients (63% males; age 61.7 ± 15.6 years), 441 with adequate preparation. The main indications were inflammatory bowel disease (26.1%) and endoscopic treatment (24.9%). Previous surgery (36.2%) and ASA score ≥3 (23.7%) were the most common comorbidities. An ASA score ≥3 was the only identified predictor for inadequate preparation in this study ( < 0.001, OR 3.28). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of model 1 were 60.3, 64.2, 21.8, and 90.7%, respectively. Model 2 had a sensitivity, specificity, PPV, and NPV of 57.5, 67.4, 22.6, and 90.5%, respectively. The AUC for the ROC curves was 0.62 for model 1, 0.62 for model 2, and 0.65 for the ASA score.
Although both models accurately predict adequate bowel preparation, they are still unreliable in predicting inadequate preparation and, as such, new models, or further optimization of current ones, are needed. Utilizing the ASA score might be an appropriate approximation of the risk for inadequate bowel preparation in tertiary hospital populations.
肠道准备是结肠镜检查的一项主要质量标准。已开发出用于识别准备不充分患者的模型，但尚未在外部队列中得到验证。我们旨在验证这些模型并确定其适用性。
回顾性纳入2019年4月至11月期间的结肠镜检查病例。每段的波士顿肠道准备量表评分≥2被视为准备充分。排除数据不足、结肠镜检查不完整和全结肠切除术病例。测试了两个模型：模型1（三环类抗抑郁药、阿片类药物、糖尿病、便秘、腹部手术、既往准备不充分、住院状态以及美国麻醉医师协会[ASA]评分≥3）；模型2（合并症、三环类抗抑郁药、便秘和腹部手术）。
我们纳入了514例患者（男性占63%；年龄61.7±15.6岁），其中441例准备充分。主要适应证为炎症性肠病（26.1%）和内镜治疗（24.9%）。既往手术（36.2%）和ASA评分≥3（23.7%）是最常见的合并症。ASA评分≥3是本研究中唯一确定的准备不充分的预测因素（<0.001，比值比3.28）。模型1的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为60.3%、64.2%、21.8%和90.7%。模型2的敏感性、特异性、PPV和NPV分别为57.5%、67.4%、22.6%和90.5%。模型1的ROC曲线下面积（AUC）为0.62，模型2为0.62，ASA评分为0.65。
尽管两个模型都能准确预测肠道准备充分情况，但在预测准备不充分方面仍然不可靠，因此需要新的模型或对现有模型进行进一步优化。在三级医院人群中，利用ASA评分可能是对肠道准备不充分风险的一个合适近似估计。
