Kindt Sébastien, Vanhooren Michele, Poortmans Pieter Jan, François Karlien
Gastroenterology and Hepatology, UZ Brussel, Brussel, Belgium.
Vrije Universiteit Brussel, Brussel, Belgium.
Endosc Int Open. 2025 May 12;13:a25658022. doi: 10.1055/a-2565-8022. eCollection 2025.
Inadequate bowel preparation (BP) negatively affects diagnostic performance of colonoscopy. Most trials assessing adequacy of bowel preparation regimens have excluded patients affected by chronic kidney disease (CKD), especially patients on dialysis. This study aimed to assess the impact of dialysis on BP quality and adenoma detection rate (ADR) and identify factors related to quality of BP.
We retrospectively compared patient-specific, preparation-specific (preparation solution, preparation regimen (split-dose vs. 1-day preparation, outpatient preparation), and colonoscopy-specific data (indication, Boston Bowel Preparation Score [BBPS], sedation type, presence of adenoma or cancer) between 79 patients on dialysis and 158 matched controls. Adequate BP was defined as a BBPS score ≧2 in every colonic segment. Significant contributors to BP were assessed by logistic regression.
Despite matching, dialysis patients were significantly older (69.0 ± 11.9 vs 64.2 ± 14.6, = 0.008) and less frequently women (30% vs 52%, = 0.002). There was no significant difference in BP or ADR between patients on dialysis and controls (85% vs 89%, = 0.39 and 35% vs 35%, = 1.00, respectively). Older age ( = 0.03), lower body mass index ( = 0.03), type of BP regimen ( <0.001), outpatient preparation ( = 0.03), and residency in residential care ( = 0.05) were significantly associated with BP adequacy. According to the logistic regression model, split-dose regimen was the main predictor of adequate BP ( <0.001, odds ratio 3.1 [1.65-5.81]).
Safe and adequate BP is achievable in dialysis patients. Bowel preparation regimen rather than treatment with dialysis influences BP quality. Split-dose preparation remains the most important determinant of adequate BP for colonoscopy, irrespective of regimen.
肠道准备不充分（BP）会对结肠镜检查的诊断性能产生负面影响。大多数评估肠道准备方案充分性的试验都排除了患有慢性肾脏病（CKD）的患者，尤其是接受透析的患者。本研究旨在评估透析对BP质量和腺瘤检出率（ADR）的影响，并确定与BP质量相关的因素。
我们回顾性比较了79例透析患者和158例匹配对照之间的患者特异性、准备特异性（准备溶液、准备方案（分剂量与1天准备、门诊准备））以及结肠镜检查特异性数据（指征、波士顿肠道准备评分[BBPS]、镇静类型、腺瘤或癌症的存在情况）。充分的BP定义为每个结肠段的BBPS评分≧2。通过逻辑回归评估BP的重要影响因素。
尽管进行了匹配，但透析患者年龄显著更大（69.0±11.9对64.2±14.6，P = 0.008），女性比例更低（30%对52%，P = 0.002）。透析患者与对照之间的BP或ADR无显著差异（分别为85%对89%，P = 0.39和35%对35%，P = 1.00）。年龄较大（P = 0.03）、体重指数较低（P = 0.03）、BP方案类型（P<0.001）、门诊准备（P = 0.03）以及居住在养老院（P = 0.05）与BP充分性显著相关。根据逻辑回归模型，分剂量方案是BP充分的主要预测因素（P<0.001，比值比3.1[1.65 - 5.81]）。
透析患者可实现安全且充分的BP。肠道准备方案而非透析治疗影响BP质量。无论方案如何，分剂量准备仍然是结肠镜检查BP充分的最重要决定因素。
