Explore the vast range of titles available.

INTRODUCTION:Inadequate bowel preparation (IBP) before colonoscopy remains a common problem. This meta-analysis aimed to assess the risk factors associated with IBP.METHODS:We searched multiple databases for studies that assessed risk factors for IBP after adjustment and reported the data as adjusted odds ratios with 95% confidence intervals. Meta-analyses were conducted using a random-effects model, and pooled adjusted odds ratios for risk factors reported in ≥ 3 studies were constructed.RESULTS:One hundred fifty-four studies with 358,257 participants were included. We analyzed 48 unique risk factors. Sociodemographic predictors of IBP were Medicaid insurance, obesity, current tobacco use, age ≥ 65 years, Black race, low education level, male sex, and unmarried status. Comorbidity-related predictors of IBP were any psychiatric disease, cirrhosis, American Society of Anesthesiologists (ASA) class ≥ 3, poor functional status, constipation, diabetes, previous abdominopelvic surgery, and hematochezia. Medication-related predictors of IBP were tricyclic antidepressants, antidepressants, opioids, nontricyclic antidepressants, and calcium channel blockers. Preparation/procedure-related predictors of IBP were brown liquid rectal effluent, any incomplete bowel preparation (BP) intake, lack of split-dose BP, increased BP-to-defecation interval, any nonadherence to dietary instructions, increased BP-to-colonoscopy interval, any BP intolerance, previous IBP, and inpatient status. Although afternoon colonoscopy was a predictor of IBP, subgroup analysis of prospective studies revealed no significant association.DISCUSSION:Our meta-analysis focused on adjusted risk factors to provide precise estimates of the most important risk factors for IBP. Our findings could help develop a validated prediction model to identify high-risk patients for IBP, improve colonoscopy outcomes, reduce the need for repeat colonoscopies, and reduce associated healthcare costs.

BackgroundInadequate bowel preparation (IBP) is associated with reduced adenoma detection. However, limited research has examined the impact of different commercial bowel preparations (CBPs) on IBP and adenoma detection. We aim to determine whether type of CBP used is associated with IBP or adenoma detection.MethodsWe retrospectively evaluated outpatient, screening or surveillance colonoscopies performed in the Cleveland Clinic health system between January 2011 and June 2017. IBP was defined by the Aronchick scale. Multilevel mixed-effects logistic regression was performed to assess the association between CBP type and IBP and adenoma detection. Fixed effects were defined as demographics, comorbidities, medication use, and colonoscopy factors. Random effect of individual endoscopist was considered.ResultsOf 153,639 colonoscopies, 75,874 records met inclusion criteria. Median age was 54; 50% were female; 17.7% had IBP, and adenoma detection rate was 32.6%. In adjusted analyses, compared to GoLYTELY, only NuLYTELY [OR 0.66 (95% CI 0.60, 0.72)] and SuPREP [OR 0.53 (95% CI 0.40, 0.69)] were associated with reduced IBP. Adenoma detection did not vary based on the type of bowel preparation used.ConclusionsAmong patients referred for screening or surveillance colonoscopy, choice of CBP was not associated with adenoma detection. Decisions about CBP should be based on other factors, such as tolerability, cost, or safety.

Adequate bowel preparation is a prerequisite for colonoscopy. However, up to 20% of colonoscopies remain inadequately prepared. Risk factors for inadequate bowel preparation often overlap with those of failed cecal intubation. This study aimed to assess the feasibility of an intraprocedural bowel cleansing system (BCS) in patients with a history of inadequate bowel preparation. Patients (n = 44) with a history of inadequate bowel preparation in the past 2 years were included. After a limited preparation with 300 mL split-dose sodium picosulfate magnesium citrate, additional cleansing during colonoscopy was performed with the BCS. The primary outcome was adequate bowel preparation using the Boston Bowel Preparation Scale (BBPS). Secondary outcomes included cecal intubation rate, procedure times, usability, and safety. Median BBPS increased from 1-2-2 (IQR 1-2) to 3-3-3 (IQR) (p < 0.0001), with 31.8% and 88.6% of patients adequately prepared before and after using the BCS, respectively (p < 0.0001). Cecal intubation rate was 88.6%. Reasons for incomplete colonoscopy were looping (n = 2), technical failure (n = 1), relative stricture (n = 1), and residual feces (n = 1). In patients with complete colonoscopy, the adequate cleansing rate was 97.5%. Median total procedure time was 26 min, of which 5.3 min were spent on cleaning. General ease of use was scored with a median of 4 out of 5, representing \"as good as conventional colonoscopy\". No serious adverse events occurred. Adequate bowel cleaning can be achieved with an intraprocedural BCS in patients with a history of inadequate bowel preparation, which may reduce repeat colonoscopies and clinical admissions for bowel preparation. However, since these patients more frequently have complicated anatomy (surgical scarring, diverticulosis, etc.), adequate patient selection is advised to avoid incomplete procedures.

Background The effectiveness in surveillance colonoscopy largely depends on the quality of bowel preparation. We aimed to investigate the quality of bowel preparation segmentally and its effect on Adenoma Detection Rate (ADR) and Advanced Adenoma Detection Rate (AADR) at corresponding bowel segments. Methods This is a single-centered and cross-sectional study. A consecutive of 5798 patients who underwent colonoscopy examination were included. Bowel preparation was evaluated based on Bowel Bubble Scale (BBS) in general and Boston Bowel Preparation Scale (BBPS) in each segment (right side, transverse and left side of colon) and total BBPS scores. The quality of bowel preparation was correlated with ADR and AADR. Results Four thousand nine hundred forty colonoscopies (14,820 bowel segments) were included in the final analysis. In which 30.9% scored 3, 57.5% scored 2, 11.2% scored 1 and 0.4% scored 0 on basis of BBPS. For each score, ADR were 10.8, 7.7, 4.9 and 3.2%, respectively; whereas AADR were 4.5, 2.8,1.8 and 1.6% ( P  < 0.05). 36.9% of the colonoscopies showed presence of minimal bubbles and 34.3% with no bubble. For bowels without bubbles and with a large amount of bubbles, ADR were 28.3 and 20.0% respectively; and AADR were 13.3 and 7.1% respectively. Conclusions Segmental bowels’ cleanliness and the amount of bubbles in bowels significantly affect ADR and AADR. The better the bowel preparation at each segment is and the less bubbles in the bowel there are, the higher ADR and AADR we got. We suggest repeating colonoscopy if any segment of the bowel preparation is poor, or if there is more bubbles, even if the total score of BBPS indicates good or fair bowel preparation.

BackgroundPoor bowel preparation is commonly observed in inpatients undergoing colonoscopy, particularly those with higher risks for inadequate bowel preparation.AimsThe objective of this study was to determine whether personalized bowel preparation regimens combined with face-to-face instruction (FFI) could improve the quality of bowel preparation for inpatient.MethodsIn this endoscopist-blinded, randomized controlled trial, 320 inpatients were enrolled and randomly allocated (1:1) to the control and intervention groups. The intervention group received FFI and personalized bowel preparation regimens, while the control group received the routine bowel preparation regimen and education. The primary outcome was adequate bowel preparation rate. Secondary outcomes included rates of procedure-related adverse events, incorrect diet restriction and laxative intake, etc.ResultsThe adequate bowel preparation rate in the intervention group was significantly higher compared to control group [intention-to-treat (ITT) analysis: 70.0% vs 51.3%, P < 0.001; per-protocol (PP) analysis: 79.4% vs 58.6%, P < 0.001]. Bowel cleanliness was significantly improved in high-risk inpatients (ITT analysis: 65% vs 44.6%, P = 0.004; PP analysis: 73.0% vs 51.7%, P = 0.004) and in low-risk inpatients (ITT analysis: 80% vs 62.7%, P = 0.037; PP analysis: 92.3% vs 69.8%, P = 0.003). There were no significant differences between two groups regarding procedure-related adverse events.ConclusionsPersonalized bowel preparation regimens combined with FFI improve the rate of adequate bowel preparation, especially for patients with high-risk factors. As such, inpatients could benefit from this novel approach for better bowel preparation to ultimately improve the quality of colonoscopies.

Introduction Shankhaprakshalana (SP) is a yogic method aiming to cleanse the bowel. It involves the use of warm saline water and a combination of five asanas. This study was designed to assess the effectiveness and safety of bowel preparation by SP. Methods This is a retrospective observational study of prospectively collected data. Patients planned for colonoscopy were screened and enrolled to undergo bowel preparation by SP on the day of the colonoscopy. Patients having comorbid conditions, poor performance status, suspected or previously diagnosed intestinal stricture and past history of major abdominal surgery and those unable to perform asanas of SP were excluded. A low-fiber diet was advised for one day before the colonoscopy. Patients were advised to drink 400 mL of lukewarm saline water followed by five asanas (exercises) of SP, each done eight times dynamically and sequentially. After completing six such cycles, patients underwent colonoscopy. Boston Bowel Preparation Scale (BBPS) score was used to assess the quality of bowel preparation. Results Total 238 patients were included. The major indications for colonoscopy were abdominal pain (35.3%), hematochezia (23.9%), diarrhea (20.2%), constipation (10.9%) and anemia (9.7%). The mean age was 37.7 (± 12) years. The mean BBPS was 8 (± 1.2). Bowel preparation was inadequate (BBPS < 6) in only two patients. Mean segmental BBPS for the three segments of the colon (right, transverse and left) was 2.6 (± 0.5), 2.7 (± 0.4) and 2.6 (± 0.7), respectively. Minor adverse events (nausea, abdominal pain, vomiting, giddiness and bloating) were noted in 10 participants (4.2%), which did not require hospitalization. Bowel preparation was completed in 133 (± 35) minutes. Conclusion Shankhaprakshalana is an effective and safe method to achieve adequate bowel preparation before colonoscopy. Since this is a single-center and retrospective study, future multi-centric, prospective studies comparing it with the standard bowel preparation regimens are warranted. Graphical abstract

Background The quality of bowel preparation significantly affects the outcome of colonoscopy. Adequate bowel cleansing improves diagnostic accuracy while reducing the need for repeat procedures. Currently, evidence regarding factors associated with inadequate bowel preparation in outpatients and inpatients remains limited. Therefore, this study aimed to compare the quality of bowel preparation between outpatients and inpatients undergoing colonoscopy and to identify risk factors for inadequate bowel preparation. Methods A total of 20,688 patients undergoing sedated colonoscopy were included in this study. Bowel preparation quality was assessed using the Boston Bowel Preparation Scale (BBPS). Propensity score matching (PSM) was used to adjust the baseline differences between the outpatients and inpatients, followed by univariate and multivariate logistic regression analyses to assess risk factors for inadequate bowel preparation. Subgroup analyses were conducted to analyze the differences in bowel preparation quality between outpatients and inpatients. Results After matching, outpatients had higher BBPS scores than inpatients (7.29 ± 1.06 vs. 6.97 ± 1.19, P  < 0.001), and had a higher rate of adequate bowel preparation compared with inpatients (95.95% vs. 93.07%, P  < 0.001). Univariate analysis showed that aged ≥ 65 years, ethnic minorities, inpatient status, diabetes, and a history of abdominal surgery were significantly related to inadequate bowel preparation (all P  < 0.001). Multivariate analysis showed that aged ≥ 65 years (OR: 1.90; 95% CI: 1.52–2.39; P  < 0.001), ethnic minorities (OR: 4.22; 95% CI: 2.91–6.12; P  < 0.001), inpatient status (OR: 1.52; 95% CI: 1.23–1.89; P  < 0.001), diabetes (OR: 1.86; 95% CI: 1.13–3.06; P  < 0.001) and a history of abdominal surgery (OR: 1.55; 95% CI: 1.25–1.93; P  < 0.001) were independent risk factors for inadequate bowel preparation. Subgroup analysis showed that rates of bowel preparation adequacy were significantly higher in outpatients than in inpatients. Conclusions Although bowel preparation quality was statistically lower in inpatients than in outpatients, the absolute difference was modest. Aged ≥ 65 years, ethnic minorities, inpatient status, diabetes, and a history of abdominal surgery were independent risk factors for inadequate bowel preparation. Clinical attention should be directed toward patients who present with a combination of these risk factors, which tend to occur more frequently in inpatient settings, to implement individualized preparation strategies.

Background Colonoscopy is a standard procedure for evaluating colon diseases and screening for colorectal cancer, and bowel cleanliness prior to colonoscopy is key. The aim of this study was to compare the bowel cleansing efficacy of low-volume (2 L) split-dose polyethylene glycol (PEG) plus single-dose (24 µg) lubiprostone (LB) and high-volume (4 L) split-dose PEG. Methods Patients scheduled to undergo outpatient colonoscopy between December 2019 and June 2021 at Rajavithi Hospital were enrolled and randomized into two groups: 2 L PEG + LB or 4 L PEG. Colon cleanliness was evaluated using the Boston Bowel Preparation Scale (BBPS) by reviewing images of the colon after completion of colonoscopy. Secondary outcomes comprised cecal intubation rate, procedure time, withdrawal time, polyp detection rate, adenoma detection rate, patient satisfaction, compliance (based on complete ingestion of bowel preparation regimen), willingness to repeat the preparation regimen, and associated adverse events. Results One hundred and forty patients were included, with 70 in each group. The mean total and segment-specific BBPS scores were not significantly different between groups. However, the rate of adequate bowel preparation was significantly higher in the 2 L PEG + LB group than the 4 L PEG group (100% [95% CI 94.6–100] versus 88.4% [95% CI 78.4–94.9], p  = 0.004) in the per-protocol analysis. Colonic polyps were the most common finding. The polyp detection rate, adenoma detection rate, and all secondary outcomes were statistically similar in the two groups ( p  > 0.05). Conclusions The combination of 2 L split-dose PEG plus LB improves bowel cleanliness (based on BBPS scores) to a comparable degree to the standard 4 L split-dose PEG, without additional adverse events and with a lower PEG volume.

Background and Objectives: Proper bowel preparation is of paramount importance for enhancing adenoma detection rates and reducing postcolonoscopic colorectal cancer risk. Despite recommendations from gastroenterology societies regarding the optimal rates of successful bowel preparation, these guidelines are frequently unmet. Various approaches have been employed to enhance the rates of successful bowel preparation, yet the quality of cleansing remains suboptimal. Intensive bowel preparation techniques, supplementary administration of bowel solutions, and educational interventions aimed at improving patient adherence to instructions have been commonly utilized, particularly among patients at a high risk of inadequate bowel preparation. Expedited strategies conducted on the same day as the procedure have also been endorsed by scientific organizations. More recently, the utilization of artificial intelligence (AI) has emerged for the preprocedural detection of inadequate bowel preparation, holding the potential to guide the preparation process immediately preceding colonoscopy. This manuscript comprehensively reviews the current strategies employed to optimize bowel cleansing, with a specific focus on patients with elevated risks for inadequate bowel preparation. Additionally, the prospective role of AI in this context is thoroughly examined. Conclusions: While a majority of outpatients may achieve cleanliness with standard cleansing protocols, dealing with hard-to-prepare patients remains a challenge. Rescue strategies based on AI are promising, but such evidence remains limited. To ensure proper bowel cleansing, a combination of strategies should be performed.

Background and Aims: Adequate bowel preparation is the cornerstone of high-quality colonoscopy. The Boston Bowel Preparation Scale (BBPS) is the gold standard for assessment, yet its application suffers from inter-observer variability and lacks a fully automated solution for entire video analysis. This study proposes EndoClean, a novel, fully automated deep learning framework designed to compute the full-segment BBPS score from colonoscopy videos, aiming to provide a standardized, objective, and near expert-level assessment. Methods: EndoClean integrates three distinct models: frame selection, anatomical segmentation, and BBPS scoring. Its performance was rigorously evaluated against a reference standard established by senior experts and compared with junior endoscopists. We assessed assessment precision, inter-rater agreement (quadratic weighted Kappa), and consistency across all colonic segments. Results: The EndoClean system demonstrated superior reliability, achieving a global accuracy of 97.8% for the total BBPS score, with satisfying agreement with senior experts (κ = 0.984; 95% CI: 0.976–0.989). Notably, EndoClean performed significantly better than junior endoscopists in overall BBPS agreements (κ: 0.984 vs. 0.949, p < 0.001) and overall accuracy (97.8% vs. 94.6%, p = 0.037). In segment-specific analysis, the EndoClean surpassed junior doctors particularly in the transverse colon (Accuracy: 97.5% vs. 90.4%, p < 0.001) and effectively reduced misclassifications in clinically ambiguous intermediate scores. For binary adequacy classification, the system achieved a sensitivity of 98.2% and a specificity of 97.3%. Conclusions: EndoClean represents a robust solution in automated quality control, demonstrating performance comparable to senior experts in bowel preparation assessment. By significantly reducing the variability seen in junior endoscopists and providing objective, full-video BBPS scoring, this framework offers a viable, standardized, and efficient solution for clinical practice and large-scale quality monitoring.