Time to Confirmed Completion of Bowel Preparation as a Preprocedural Indicator of Colonoscope Insertion Difficulty: A Prospective Observational Study.
Time to confirmed completion of bowel preparation may indicate potential difficulties during colonoscopy, with longer times linked to increased insertion challenges.
Where it sits
this study against the rest of the bpc-157 corpusSummary and findings
This study examined the relationship between bowel preparation indicators and colonoscope insertion difficulty in 185 patients undergoing unsedated colonoscopy. The primary focus was on the time to confirmed completion of bowel preparation and its association with cecal intubation time and loop formation. No therapeutic claims are made regarding the findings.
Abstract
<h4>Background and aims</h4>Runway time, defined as the interval between completion of polyethylene glycol ingestion and the start of colonoscopy, has been studied as a determinant of bowel cleansing quality. However, whether the bowel preparation course itself is associated with colonoscope insertion difficulty remains unclear. We aimed to examine the associations of bowel preparation course indicators with cecal intubation time (CIT) and loop formation.<h4>Methods</h4>In this single-center prospective observational study, we enrolled consecutive patients undergoing unsedated colonoscopy and prospectively recorded four bowel preparation course indicators: time to first bowel movement, time to confirmed completion of bowel preparation, total number of bowel movements, and estimated stool volume. Multivariable linear regression analysis was performed using log-transformed CIT as the dependent variable and adjusting for age, sex, body mass index (BMI), and endoscopist. Associations with loop formation were examined using multivariable logistic regression analysis adjusted for age, BMI, and endoscopist.<h4>Results</h4>A total of 185 patients were included. Among the four indicators, only the time to confirmed completion of bowel preparation was associated with insertion difficulty. In multivariable linear regression analysis, each 30-min increase in time to confirmed completion of bowel preparation was associated with longer CIT (exp(β), 1.139; 95% confidence interval [CI], 1.065-1.219). In multivariable logistic regression analysis, it was also associated with loop formation (odds ratio, 1.624; 95% CI, 1.129-2.360, per 30-min increase).<h4>Conclusions</h4>Time to confirmed completion of bowel preparation may serve as a simple preprocedural indicator of colonoscope insertion difficulty.<h4>Trial registration</h4>N/A.
Background
This study addresses the unclear relationship between bowel preparation indicators and colonoscope insertion difficulty. Previous research has focused on bowel cleansing quality but has not definitively linked preparation time to procedural challenges. Understanding these associations could enhance procedural efficiency and patient experience.
Methods
This was a single-center prospective observational study involving 185 consecutive patients undergoing unsedated colonoscopy. Four bowel preparation indicators were recorded: time to first bowel movement, time to confirmed completion of bowel preparation, total number of bowel movements, and estimated stool volume. The primary outcome measure was cecal intubation time, analyzed using multivariable linear regression.
Results
The primary finding was that each 30-min increase in time to confirmed completion of bowel preparation was associated with longer cecal intubation time (exp(β), 1.139; 95% CI, 1.065-1.219). Additionally, this time was associated with loop formation, with an odds ratio of 1.624 (95% CI, 1.129-2.360) for each 30-min increase.
Interpretation
The findings suggest that longer preparation times may correlate with increased difficulty during colonoscopy, aligning with some previous literature on procedural challenges. However, the effect sizes, while statistically significant, may not reflect a clinically meaningful impact on practice without further validation. The study's limitations, including its observational design and potential confounding factors, warrant caution in interpreting the results.
Key findings
- Each 30-min increase in time to confirmed completion of bowel preparation was associated with longer cecal intubation time (exp(β), 1.139; 95% CI, 1.065-1.219).
- Each 30-min increase in time to confirmed completion of bowel preparation was associated with loop formation (odds ratio, 1.624; 95% CI, 1.129-2.360).
- A total of 185 patients were included in the study.
Limitations
- single-center design limits generalizability
- observational nature may introduce confounding factors
- no randomization or control group