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Su1559 Same-Day Esophagogastroduodenoscopy (EGD) Performed Before Colonoscopy Does Not Impact Quality of Bowel Preparation or Detection of Polyps
Abstracts
Su1556 A Comparison of a Standard Volume Polyethylene Glycol Solution and Low Volume Polyethylene Glycol Plus Ascorbic Acid As Bowel Preparation Prior to Screening Colonoscopy Alex J. Ball*, Stuart a. Riley Gastroenterology, Sheffield Teaching Hospitals, Sheffield, United Kingdom Introduction: Low volume PEG plus ascorbic acid and standard volume PEG solutions are commonly used as bowel preparation prior to colonoscopy but comparative studies report conflicting results. The study aimed to compare these solutions prior to screening colonoscopy. Methods: Patient experience and bowel cleanliness were compared in consecutive patients attending for morning and afternoon screening colonoscopy examinations in the South Yorkshire and Bassetlaw Bowel Cancer Screening Programme. Patients scheduled for a morning colonoscopy took their bowel preparation the day before, whereas patients scheduled for an afternoon colonoscopy took their preparation as a split dose. This study occurred during a planned switch over from a standard volume to a low volume PEG solution. Patients were asked to rate acceptability, side effects and willingness to undergo a repeat bowel preparation. Bowel cleanliness was rated using the Ottawa scale. Categorical data was compared using the chi-square test. Results The study included 150/194 patients who underwent screening colonoscopy during the study period. An equal number of patients received the standard (75) and low volume PEG solution (75). 60 patients in each group had morning examinations and 15 had afternoon examination. Full adherence to the low volume PEG solution was better (73/75 (97%) vs. 65/ 75 (87%), odds ratio (OR) 5.6, 95% CIZ1.18-16.2, pZ0.02) and taste was judged unacceptable less often (22/75 (29%) vs. 37/75 (49%), OR 2.35, 95% CI 1.2-4.6, pZ0.01) than the standard volume preparation. There were no differences in the frequency of side effects between bowel preparations, although patients taking the standard volume solution were more likely to rate volume as unacceptable when scheduled for a morning colonoscopy (19/60 (32%) vs. 1/15 (7%), OR 6.5, 95% CI 0.8-53.0, pZ0.05). More patients were willing to repeat the low than the standard volume PEG Solution (71/75 (95%) vs. 61/75 (81%), OR 4.1, 95% CI Z 1.2-13.0, pZ0.01). There were no significant differences in bowel cleanliness between preparations but patients taking the standard volume preparation scheduled for a morning colonoscopy were more likely to have bowel cleanliness rated as good or excellent in the right colon (19/60 (31.6%) vs. 9/60 (15%), OR 2.62, 95% CIZ1.076.41, pZ0.04). Patients taking both bowel preparations who were scheduled for afternoon colonoscopy were more likely to have bowel cleanliness rated as good or excellent compared to patients scheduled for a morning colonoscopy in all bowel segments (table 1). Conclusions The low volume PEG preparation was better tolerated but resulted in less effective bowel cleansing during colonoscopies scheduled in the morning. The timing of colonoscopy is an important determinant of bowel cleanliness with both PEG solutions.
Bowel preparation
Bowel segment
Standard volume PEG solution
Right Mid Rectosigmoid Right Mid Rectosigmoid
Low volume PEG solution
Morning list
Afternoon list
p OR (95% CI) Value
19/60 (32%) 10/15 (67%) 4.3 (1.3-14.4) 25/60 (42%) 12/15 (80%) 5.6 (1.4-21.9) 28/60 (47%) 12/15 (80%) 4.6 (1.2-17.9)
0.01 0.01 0.02
9/60 (15%) 9/15 (60%) 8.5 (2.4-29.8) !0.001 21/60 (35%) 10/15 (67%) 3.7 (1.1-12.3) 0.03 20/60 (33%) 11/15 (73%) 5.5 (1.6-19.5) 0.005
Number of patients with cleanliness rated as good or better in morning and afternoon examinations.
Su1557 Is the Menthol Candy Drops Able to Help the Patients to Take Polyethylene Glycol (PEG) Solution? Jong Soo Lee, Yoon Tae Jeen*, Seung Han Kim, Jae MIN Lee, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Hoon Jai Chun, Hongsik Lee, Chang Duck Kim, Seung Joo Nam Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea Background and Aim: Polyethylene glycol (PEG)-based solution is widely used for bowel cleansing before colonoscopy but has poor compliance. Recently, Polyethylene Glycol with ascorbic acid (PEG-Asc) has developed for low-volume and better taste. But, this still requires the moderate amount of volume and has brought just a little of taste improvement. The aim of this study was to test the effectiveness of menthol candy drops in improving tolerability and bowel cleansing of PEG-Asc. Methods: Single center, randomized study was performed during July to September 2013. Total 100 out-patients were prospectively enrolled and received colonoscopy using split-dose PEG-Asc preparation method; 50 subjects (PEG-Asc group) and 50
www.giejournal.org
subjects (PEG-Asc plus menthol candy group). In the PEG-Asc plus menthol candy group, patients were provided 15 menthol candy drops and instructed to suck on a candy while drinking the split-dose PEG-Asc solution. The patients underwent strict diet restriction; not allowed to eat non-digestable food like fruits, vegetables, minor cereals for 3 days before procedure. We used the Boston bowel preparation scale and Aronchic bowel preparation scale for evaluation of bowel cleansing. To investigate the compliance, a questionnaire was performed before colonoscopy. Results: There were no significant differences between two-groups in the aspect of cecal intubation time and total examination time. In the compliance, nausea were less and taste of solution were better in menthol candy group compared to PEG-Asc alone group (P!0.05). In the aspect of the preparation quality, all patients in two groups showed good quality (mean Boston scale score; PEG+Asc alone group 7.22 1.32, Menthol candy group 7.64 1.19, 72.7% excellent or good grade in Aronchick scale) but there were no significant differences between two-groups. Considering the total number of ingested menthol candy, patients who had 10 or more candies showed better bowel cleansing quality(mean 8.37 0.74 Boston scale score, range 7-9; 87.5% excellent grade in Aronchick scale) but it was not statistically significant. Conclusions: The menthol candy drops improve the compliance and taste of PEGAsc, but not associated with bowel cleansing effect.
Su1558 Patient Perception of Bowel Preparation for Colonoscopy Is Inflated Compared to Endoscopist Assessment of Rectal Effluent Kimberly J. Fairley1, Kimberly J. Chaput*1, Amir N. Rezk2, M. J. Shellenberger1, Stacy Prall1, Genci P. Babameto1, Khurram Zakaria2, Nicholas a. Inverso1 1 Gastroenterology, Geisinger Medical Center, Danville, PA; 2Medicine, Geisinger Medical Center, Danville, PA Background: Limited data are available on the accuracy of patient assessment of bowel preparation prior to colonoscopy. Prior studies often used written patient surveys and have not been shown to correlate well with the endoscopist’s assessment. Moreover, few studies provided patients with a visual placard at the completion of bowel preparation to foster patient understanding of adequate colon cleansing. Aim: Our study compares patient perception of bowel preparation through written and pictorial descriptions of final evacuation to physician evaluations of residual contents. Design: We performed a prospective analysis of 1099 consecutive outpatients undergoing colonoscopy between 02/2013- 09/2013. Patients completed a questionnaire that included the character of stool output and image selection that most closely represented final effluent. Physicians also scored prep quality and selected images of the stool from the same choices. Exclusion criteria were patients under 18 years old, pregnant, blind, chronic kidney disease (CKD) O stage III, or prior colon surgery. Other data collected included age, sex, prep type, adverse prep events and quantity of bowel prep completed. Results: 1099 consecutive patients at our tertiary center were analyzed. 35 patients were excluded by the criteria above. Among 1064 patients, 541 (51%) were male. Comorbidities including Diabetes, Hypothyroidism, COPD, and CKD ! Stage III were present in 39.3, 33.8, 10.3, and 10.3% of patients respectively. 85(8%) had inadequate preps requiring repeat exam. 89% of patients completed O 75% of the prep, while none consumed! 25%. Commonly, nausea prevented completing the full volume of prep (31.7%). 16.7% stopped the prep prematurely believing their stools were clear. A significant difference occurred between patient perception of an inadequate prep (solid or dark liquid stool) as identified by written patient survey compared to selfselection of an image of an inadequate prep (6.5% vs. 11.4%; p ! 0.0003). Endoscopists identified an inadequate prep 22.7% of the time based on the picture placard, a two-fold increase from the patient’s visual assessment (p ! 0.0001). For adequate preps (transparent colored stools) good correlation occurred between written and pictorial patient self-assessments. For those with the most thorough ("clear") prep, patients still significantly overrated the cleanliness of preps via pictorial placard as compared to the physician’s image selection (18.35% vs. 8.2%; p ! 0.0001). Discussion: Our data reveals that patients often overestimate thoroughness of bowel cleansing by written and pictorial descriptors as compared to the physician assessment during colonoscopy. A standardized visual placard of interim and final stool output may permit patients to improve preparation and optimize exam quality.
Su1559 Same-Day Esophagogastroduodenoscopy (EGD) Performed Before Colonoscopy Does Not Impact Quality of Bowel Preparation or Detection of Polyps Stephanie Judd*1,2, Sujan Ravi3, Zaher Hakim1,2, Rana Sabbagh2, Fadi Antaki1 1 Internal Medicine/Gastroenterology, John D. Dingell VA Medical Center and Wayne State University, Detroit, MI; 2Internal Medicine/ Gastroenterology, Detroit Medical Center, Detroit, MI; 3Internal Medicine, University of Alabama at Birmingham, Birmingham, AL Introduction: It is common to perform EGD immediately prior to colonoscopy for many indications, such as iron deficiency anemia. The effect of this practice on bowel preparation (prep) quality has never been studied. Our hypothesis is that air
Volume 79, No. 5S : 2014 GASTROINTESTINAL ENDOSCOPY AB213
Abstracts
insufflation during EGD may push bile and secretions downstream into the right colon resulting in a poorer colon prep. The goal of this study is to determine whether EGD completed immediately prior to colonoscopy impacts bowel preparation and polyp detection rate. Methods: A retrospective chart review study was conducted of consecutive subjects who had an outpatient colonoscopy or same-day EGD and colonoscopy performed during an 8-month period at one institution. Bowel preparation at the time of this study consisted of conventional dosing of a 4liter polyethylene glycol solution with bisacodyl 15 mg given the evening prior to endoscopy. Exclusion criteria included colonoscopies aborted for any reason other than poor prep, inpatient colonoscopy, and colonoscopies repeated because of prior poor prep. Data collected included gender, race, indication for colonoscopy, history of polyps or colorectal cancer (CRC), endoscopic findings including number and pathology of polyps, and prep quality. Chi-square test and two-tailed t-test were used to analyze the data. Results: Information was collected from 863 charts. Sameday EGD was performed prior to colonoscopy in 154 cases (18%). Mean age of the group was 60 years. The majority were male (93.3%). The study group included 439 African-Americans (50.9%) and 412 Caucasians (47.7%). 452 colonoscopies were performed for screening (52.4%) and 411 were performed for diagnostic purposes (47.6%). 234 patients (27.1%) had a prior history of polyps or CRC. No significant differences were found in detection of polyps, adenomas, right-sided polyps, or high risk polyps between patients who had same-day EGD/colonoscopy or only colonoscopy. However, there was a trend toward poorer prep quality and decreased polyp and adenoma detection rates in the group who had both EGD and colonoscopy performed (Table 1). The results were similar when assessed for colonoscopy aborted, repeat colonoscopy recommended at short intervals, and examiners assessment of the quality of the bowel prep. Conclusion: Performing an EGD immediately prior to colonoscopy does not significantly impact prep quality or detection of polyps, adenomas, right-sided polyps, or high-risk polyps. Concerns about prep quality or polyp detection should not influence endoscopists’ decision to perform same-day EGD prior to colonoscopy. Split-dosing of bowel prep regimen might lead to different results.
tionally, we found that patients presenting with lower Gastrointestinal bleeding have a better bowel preparation than patients with other indications for colonoscopy. Finally, our center’s data indicates that for inpatients, time interval between start of Polyethylene glycol preparation and colonoscopy is a very significant variable determining bowel preparation quality. Controlling this time interval continues to be a challenge in the inpatient setting due to several factors including - lack of dedicated endoscopy rooms for inpatient procedures at many centers, varying times of admission, as well as varying times of inpatient Gastroenterology consult.
Covariates Covariates
Univariate p values
Multivariable p values
Age Gender
0.377 0.066
Race Marital Status Narcotic use within two days prior to colonoscopy Adjunct laxative use (in addition to Polyethylene glycol preparation) within two days prior to colonoscopy Diet status 24hrs prior to colonoscopy Bleeding vs. non-bleeding indication for colonoscopy All indications for colonoscopy Time interval between start of bowel preparation and start of colonoscopy
0.379 0.412 0.825
0.395 0.018* [ORZ1.785; 95% CI(1.105, 2.88)] 0.369 0.538 0.715
0.889
0.816
0.632 0.043*
0.938 0.028* [ORZ1.742; 95% CI(1.062, 2.857)] 0.118 0.002*
0.067 ! 0.001*
* statistically significant at 0.05 alpha level Variable N Polyp detection, n (%) Adenoma detection, n (%) Poor prep, n (%) Colonoscopy aborted due to poor prep, n (%) Repeat colonoscopy recommended at short intervals, n (%) Polyp detection in right colon, n (%) Detection of high risk polyps, n (%)
Colonoscopy 709 437 (58.6%) 313 (41.9%) 79 (10.6%) 22 (2.9%)
EGD + Colonoscopy 65 44 15 5
154 (55.6%) (37.6%) (12.8%) (4.3%)
pvalue 0.54 0.37 0.47 0.44
52 (6.9%)
11 (9.4%)
0.34
279 (37.4%) 90 (12.1%)
38 (32.5%) 9 (7.7%)
0.31 0.16
Su1560 Analysis of Inpatient Bowel Preparation At a Teaching Hospital Syed K. Mahmood*1, Emily J. Campbell2, Hui Zheng3, James M. Richter2 1 Internal Medicine, Massachusetts General Hospital, Boston, MA; 2 Gastroenterology, Massachusetts General Hospital, Boston, MA; 3 Biostatistics, Massachusetts General Hospital, Boston, MA Aim: Published data has shown that inpatients undergoing colonoscopy differ from their outpatient counterparts in several important characteristics, including age, co morbidities, poly-pharmacy, and indications for the procedure. Our study was conducted exclusively on inpatients, to ascertain clinically and statistically significant variables affecting bowel preparation quality in the hospitalized setting. Methods: We collected inpatient colonoscopy data on 377 consecutive inpatients over nine months in 2012. Excluded sigmoidoscopies, "travel cases" and patients who were not administered Polyethylene glycol preparation prior to colonoscopy. Electronic medical records were used to gather data. Our center uses a five-point bowel preparation grading scale (modification of the Aronchick scale). Outcome variable for was bowel preparation quality (which we dichotomized as acceptable if patients scored "Excellent" or "Good" on the scale and not acceptable for lesser grades). Covariates listed in attached table. Constructed logistic regression models and generated Odds ratios. Investigators used STATA13 for all calculations. Limitations: data on stop time of Polyethylene glycol ingestion was not available in a consistent manner and hence was not included in our analysis. Results: Statistical analysis suggests that time between Polyethylene glycol preparation and colonoscopy was a very significant variable (pZ0.002) on multivariable analysis. Additionally, gender was statistically significant (multivariable pZ0.018) with females prepping better than males [ORZ1.785; 95% CI(1.105, 2.88)]. Finally, when we broke down indication for colonoscopy by bleeding vs. non-bleeding (bleeding being the largest subgroup), the p value was significant (pZ0.028) on multivariable analysis. Patients with lower GI bleeding tend to prep better than non-lower GI bleeders [ORZ1.742; 95% CI(1.062, 2.857)]. Conclusions: Our center’s data suggests that in the inpatient setting, females tend to have better bowel preparation quality than males. Addi-
AB214 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014
Patient characteristics Patient characteristics O 60 Males Caucasian African American Hispanic Asian Other Unknown/Not listed Marital status Married Narcotic use within two days prior to colonoscopy Dulcolax Adjunct laxative use (in addition to Colace Polyethylene glycol preparation) within two days prior to colonoscopy Miralax Senna Lactulose Magnesium Citrate Diet status 24hrs prior to colonoscopy Clear liquid with NPO after midnight NPO only Other Indication for Gastroenterology consult Lower GI bleeding Other Indication for colonoscopy Lower GI bleeding Other Age Gender Race
n
%
230 217 315 22 15 11 2 10 188 110 72 59 30 41 13 23 243
61.17 57.71 83.78 5.85 4.26 2.93 0.53 2.66 51.09 29.33 19.5 15.69 7.98 10.9 3.46 6.12 64.8
55 77 194 182 218 158
14.67 20.53 51.6 48.4 57.98 42.02
Su1561 Patient-Related Factors Affecting Bowel Preparation Prior to Colonoscopy Juan S. Lasa*1, Melisa T. Senderovsky1, Ignacio Fanjul1, Rafael Moore1, Guillermo Dima1, Angel D. Peralta1, Ignacio Zubiaurre1, Abel Novillo2, Luis O. Soifer1 1 Gastroenterology, CEMIC, Buenos Aires, Argentina; 2Gastroenterology, Sanatorio 9 de Julio, San Miguel de Tucumán, Argentina Background: Colonoscopy is a colorectal cancer (CRC) screening tool that allows complete exploration of colonic mucosa and the chance to resect adenomatous lesions. Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance. Much emphasis has been made on procedure-related factors influencing bowel preparation quality, such as the timing of purgative administration. There is less evidence on patient-related factors that may
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Su1556 A Comparison of a Standard Volume Polyethylene Glycol Solution and Low Volume Polyethylene Glycol Plus Ascorbic Acid As Bowel Preparation Prior to Screening Colonoscopy Alex J. Ball*, Stuart a. Riley Gastroenterology, Sheffield Teaching Hospitals, Sheffield, United Kingdom Introduction: Low volume PEG plus ascorbic acid and standard volume PEG solutions are commonly used as bowel preparation prior to colonoscopy but comparative studies report conflicting results. The study aimed to compare these solutions prior to screening colonoscopy. Methods: Patient experience and bowel cleanliness were compared in consecutive patients attending for morning and afternoon screening colonoscopy examinations in the South Yorkshire and Bassetlaw Bowel Cancer Screening Programme. Patients scheduled for a morning colonoscopy took their bowel preparation the day before, whereas patients scheduled for an afternoon colonoscopy took their preparation as a split dose. This study occurred during a planned switch over from a standard volume to a low volume PEG solution. Patients were asked to rate acceptability, side effects and willingness to undergo a repeat bowel preparation. Bowel cleanliness was rated using the Ottawa scale. Categorical data was compared using the chi-square test. Results The study included 150/194 patients who underwent screening colonoscopy during the study period. An equal number of patients received the standard (75) and low volume PEG solution (75). 60 patients in each group had morning examinations and 15 had afternoon examination. Full adherence to the low volume PEG solution was better (73/75 (97%) vs. 65/ 75 (87%), odds ratio (OR) 5.6, 95% CIZ1.18-16.2, pZ0.02) and taste was judged unacceptable less often (22/75 (29%) vs. 37/75 (49%), OR 2.35, 95% CI 1.2-4.6, pZ0.01) than the standard volume preparation. There were no differences in the frequency of side effects between bowel preparations, although patients taking the standard volume solution were more likely to rate volume as unacceptable when scheduled for a morning colonoscopy (19/60 (32%) vs. 1/15 (7%), OR 6.5, 95% CI 0.8-53.0, pZ0.05). More patients were willing to repeat the low than the standard volume PEG Solution (71/75 (95%) vs. 61/75 (81%), OR 4.1, 95% CI Z 1.2-13.0, pZ0.01). There were no significant differences in bowel cleanliness between preparations but patients taking the standard volume preparation scheduled for a morning colonoscopy were more likely to have bowel cleanliness rated as good or excellent in the right colon (19/60 (31.6%) vs. 9/60 (15%), OR 2.62, 95% CIZ1.076.41, pZ0.04). Patients taking both bowel preparations who were scheduled for afternoon colonoscopy were more likely to have bowel cleanliness rated as good or excellent compared to patients scheduled for a morning colonoscopy in all bowel segments (table 1). Conclusions The low volume PEG preparation was better tolerated but resulted in less effective bowel cleansing during colonoscopies scheduled in the morning. The timing of colonoscopy is an important determinant of bowel cleanliness with both PEG solutions.
Bowel preparation
Bowel segment
Standard volume PEG solution
Right Mid Rectosigmoid Right Mid Rectosigmoid
Low volume PEG solution
Morning list
Afternoon list
p OR (95% CI) Value
19/60 (32%) 10/15 (67%) 4.3 (1.3-14.4) 25/60 (42%) 12/15 (80%) 5.6 (1.4-21.9) 28/60 (47%) 12/15 (80%) 4.6 (1.2-17.9)
0.01 0.01 0.02
9/60 (15%) 9/15 (60%) 8.5 (2.4-29.8) !0.001 21/60 (35%) 10/15 (67%) 3.7 (1.1-12.3) 0.03 20/60 (33%) 11/15 (73%) 5.5 (1.6-19.5) 0.005
Number of patients with cleanliness rated as good or better in morning and afternoon examinations.
Su1557 Is the Menthol Candy Drops Able to Help the Patients to Take Polyethylene Glycol (PEG) Solution? Jong Soo Lee, Yoon Tae Jeen*, Seung Han Kim, Jae MIN Lee, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Hoon Jai Chun, Hongsik Lee, Chang Duck Kim, Seung Joo Nam Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea Background and Aim: Polyethylene glycol (PEG)-based solution is widely used for bowel cleansing before colonoscopy but has poor compliance. Recently, Polyethylene Glycol with ascorbic acid (PEG-Asc) has developed for low-volume and better taste. But, this still requires the moderate amount of volume and has brought just a little of taste improvement. The aim of this study was to test the effectiveness of menthol candy drops in improving tolerability and bowel cleansing of PEG-Asc. Methods: Single center, randomized study was performed during July to September 2013. Total 100 out-patients were prospectively enrolled and received colonoscopy using split-dose PEG-Asc preparation method; 50 subjects (PEG-Asc group) and 50
www.giejournal.org
subjects (PEG-Asc plus menthol candy group). In the PEG-Asc plus menthol candy group, patients were provided 15 menthol candy drops and instructed to suck on a candy while drinking the split-dose PEG-Asc solution. The patients underwent strict diet restriction; not allowed to eat non-digestable food like fruits, vegetables, minor cereals for 3 days before procedure. We used the Boston bowel preparation scale and Aronchic bowel preparation scale for evaluation of bowel cleansing. To investigate the compliance, a questionnaire was performed before colonoscopy. Results: There were no significant differences between two-groups in the aspect of cecal intubation time and total examination time. In the compliance, nausea were less and taste of solution were better in menthol candy group compared to PEG-Asc alone group (P!0.05). In the aspect of the preparation quality, all patients in two groups showed good quality (mean Boston scale score; PEG+Asc alone group 7.22 1.32, Menthol candy group 7.64 1.19, 72.7% excellent or good grade in Aronchick scale) but there were no significant differences between two-groups. Considering the total number of ingested menthol candy, patients who had 10 or more candies showed better bowel cleansing quality(mean 8.37 0.74 Boston scale score, range 7-9; 87.5% excellent grade in Aronchick scale) but it was not statistically significant. Conclusions: The menthol candy drops improve the compliance and taste of PEGAsc, but not associated with bowel cleansing effect.
Su1558 Patient Perception of Bowel Preparation for Colonoscopy Is Inflated Compared to Endoscopist Assessment of Rectal Effluent Kimberly J. Fairley1, Kimberly J. Chaput*1, Amir N. Rezk2, M. J. Shellenberger1, Stacy Prall1, Genci P. Babameto1, Khurram Zakaria2, Nicholas a. Inverso1 1 Gastroenterology, Geisinger Medical Center, Danville, PA; 2Medicine, Geisinger Medical Center, Danville, PA Background: Limited data are available on the accuracy of patient assessment of bowel preparation prior to colonoscopy. Prior studies often used written patient surveys and have not been shown to correlate well with the endoscopist’s assessment. Moreover, few studies provided patients with a visual placard at the completion of bowel preparation to foster patient understanding of adequate colon cleansing. Aim: Our study compares patient perception of bowel preparation through written and pictorial descriptions of final evacuation to physician evaluations of residual contents. Design: We performed a prospective analysis of 1099 consecutive outpatients undergoing colonoscopy between 02/2013- 09/2013. Patients completed a questionnaire that included the character of stool output and image selection that most closely represented final effluent. Physicians also scored prep quality and selected images of the stool from the same choices. Exclusion criteria were patients under 18 years old, pregnant, blind, chronic kidney disease (CKD) O stage III, or prior colon surgery. Other data collected included age, sex, prep type, adverse prep events and quantity of bowel prep completed. Results: 1099 consecutive patients at our tertiary center were analyzed. 35 patients were excluded by the criteria above. Among 1064 patients, 541 (51%) were male. Comorbidities including Diabetes, Hypothyroidism, COPD, and CKD ! Stage III were present in 39.3, 33.8, 10.3, and 10.3% of patients respectively. 85(8%) had inadequate preps requiring repeat exam. 89% of patients completed O 75% of the prep, while none consumed! 25%. Commonly, nausea prevented completing the full volume of prep (31.7%). 16.7% stopped the prep prematurely believing their stools were clear. A significant difference occurred between patient perception of an inadequate prep (solid or dark liquid stool) as identified by written patient survey compared to selfselection of an image of an inadequate prep (6.5% vs. 11.4%; p ! 0.0003). Endoscopists identified an inadequate prep 22.7% of the time based on the picture placard, a two-fold increase from the patient’s visual assessment (p ! 0.0001). For adequate preps (transparent colored stools) good correlation occurred between written and pictorial patient self-assessments. For those with the most thorough ("clear") prep, patients still significantly overrated the cleanliness of preps via pictorial placard as compared to the physician’s image selection (18.35% vs. 8.2%; p ! 0.0001). Discussion: Our data reveals that patients often overestimate thoroughness of bowel cleansing by written and pictorial descriptors as compared to the physician assessment during colonoscopy. A standardized visual placard of interim and final stool output may permit patients to improve preparation and optimize exam quality.
Su1559 Same-Day Esophagogastroduodenoscopy (EGD) Performed Before Colonoscopy Does Not Impact Quality of Bowel Preparation or Detection of Polyps Stephanie Judd*1,2, Sujan Ravi3, Zaher Hakim1,2, Rana Sabbagh2, Fadi Antaki1 1 Internal Medicine/Gastroenterology, John D. Dingell VA Medical Center and Wayne State University, Detroit, MI; 2Internal Medicine/ Gastroenterology, Detroit Medical Center, Detroit, MI; 3Internal Medicine, University of Alabama at Birmingham, Birmingham, AL Introduction: It is common to perform EGD immediately prior to colonoscopy for many indications, such as iron deficiency anemia. The effect of this practice on bowel preparation (prep) quality has never been studied. Our hypothesis is that air
Volume 79, No. 5S : 2014 GASTROINTESTINAL ENDOSCOPY AB213
Abstracts
insufflation during EGD may push bile and secretions downstream into the right colon resulting in a poorer colon prep. The goal of this study is to determine whether EGD completed immediately prior to colonoscopy impacts bowel preparation and polyp detection rate. Methods: A retrospective chart review study was conducted of consecutive subjects who had an outpatient colonoscopy or same-day EGD and colonoscopy performed during an 8-month period at one institution. Bowel preparation at the time of this study consisted of conventional dosing of a 4liter polyethylene glycol solution with bisacodyl 15 mg given the evening prior to endoscopy. Exclusion criteria included colonoscopies aborted for any reason other than poor prep, inpatient colonoscopy, and colonoscopies repeated because of prior poor prep. Data collected included gender, race, indication for colonoscopy, history of polyps or colorectal cancer (CRC), endoscopic findings including number and pathology of polyps, and prep quality. Chi-square test and two-tailed t-test were used to analyze the data. Results: Information was collected from 863 charts. Sameday EGD was performed prior to colonoscopy in 154 cases (18%). Mean age of the group was 60 years. The majority were male (93.3%). The study group included 439 African-Americans (50.9%) and 412 Caucasians (47.7%). 452 colonoscopies were performed for screening (52.4%) and 411 were performed for diagnostic purposes (47.6%). 234 patients (27.1%) had a prior history of polyps or CRC. No significant differences were found in detection of polyps, adenomas, right-sided polyps, or high risk polyps between patients who had same-day EGD/colonoscopy or only colonoscopy. However, there was a trend toward poorer prep quality and decreased polyp and adenoma detection rates in the group who had both EGD and colonoscopy performed (Table 1). The results were similar when assessed for colonoscopy aborted, repeat colonoscopy recommended at short intervals, and examiners assessment of the quality of the bowel prep. Conclusion: Performing an EGD immediately prior to colonoscopy does not significantly impact prep quality or detection of polyps, adenomas, right-sided polyps, or high-risk polyps. Concerns about prep quality or polyp detection should not influence endoscopists’ decision to perform same-day EGD prior to colonoscopy. Split-dosing of bowel prep regimen might lead to different results.
tionally, we found that patients presenting with lower Gastrointestinal bleeding have a better bowel preparation than patients with other indications for colonoscopy. Finally, our center’s data indicates that for inpatients, time interval between start of Polyethylene glycol preparation and colonoscopy is a very significant variable determining bowel preparation quality. Controlling this time interval continues to be a challenge in the inpatient setting due to several factors including - lack of dedicated endoscopy rooms for inpatient procedures at many centers, varying times of admission, as well as varying times of inpatient Gastroenterology consult.
Covariates Covariates
Univariate p values
Multivariable p values
Age Gender
0.377 0.066
Race Marital Status Narcotic use within two days prior to colonoscopy Adjunct laxative use (in addition to Polyethylene glycol preparation) within two days prior to colonoscopy Diet status 24hrs prior to colonoscopy Bleeding vs. non-bleeding indication for colonoscopy All indications for colonoscopy Time interval between start of bowel preparation and start of colonoscopy
0.379 0.412 0.825
0.395 0.018* [ORZ1.785; 95% CI(1.105, 2.88)] 0.369 0.538 0.715
0.889
0.816
0.632 0.043*
0.938 0.028* [ORZ1.742; 95% CI(1.062, 2.857)] 0.118 0.002*
0.067 ! 0.001*
* statistically significant at 0.05 alpha level Variable N Polyp detection, n (%) Adenoma detection, n (%) Poor prep, n (%) Colonoscopy aborted due to poor prep, n (%) Repeat colonoscopy recommended at short intervals, n (%) Polyp detection in right colon, n (%) Detection of high risk polyps, n (%)
Colonoscopy 709 437 (58.6%) 313 (41.9%) 79 (10.6%) 22 (2.9%)
EGD + Colonoscopy 65 44 15 5
154 (55.6%) (37.6%) (12.8%) (4.3%)
pvalue 0.54 0.37 0.47 0.44
52 (6.9%)
11 (9.4%)
0.34
279 (37.4%) 90 (12.1%)
38 (32.5%) 9 (7.7%)
0.31 0.16
Su1560 Analysis of Inpatient Bowel Preparation At a Teaching Hospital Syed K. Mahmood*1, Emily J. Campbell2, Hui Zheng3, James M. Richter2 1 Internal Medicine, Massachusetts General Hospital, Boston, MA; 2 Gastroenterology, Massachusetts General Hospital, Boston, MA; 3 Biostatistics, Massachusetts General Hospital, Boston, MA Aim: Published data has shown that inpatients undergoing colonoscopy differ from their outpatient counterparts in several important characteristics, including age, co morbidities, poly-pharmacy, and indications for the procedure. Our study was conducted exclusively on inpatients, to ascertain clinically and statistically significant variables affecting bowel preparation quality in the hospitalized setting. Methods: We collected inpatient colonoscopy data on 377 consecutive inpatients over nine months in 2012. Excluded sigmoidoscopies, "travel cases" and patients who were not administered Polyethylene glycol preparation prior to colonoscopy. Electronic medical records were used to gather data. Our center uses a five-point bowel preparation grading scale (modification of the Aronchick scale). Outcome variable for was bowel preparation quality (which we dichotomized as acceptable if patients scored "Excellent" or "Good" on the scale and not acceptable for lesser grades). Covariates listed in attached table. Constructed logistic regression models and generated Odds ratios. Investigators used STATA13 for all calculations. Limitations: data on stop time of Polyethylene glycol ingestion was not available in a consistent manner and hence was not included in our analysis. Results: Statistical analysis suggests that time between Polyethylene glycol preparation and colonoscopy was a very significant variable (pZ0.002) on multivariable analysis. Additionally, gender was statistically significant (multivariable pZ0.018) with females prepping better than males [ORZ1.785; 95% CI(1.105, 2.88)]. Finally, when we broke down indication for colonoscopy by bleeding vs. non-bleeding (bleeding being the largest subgroup), the p value was significant (pZ0.028) on multivariable analysis. Patients with lower GI bleeding tend to prep better than non-lower GI bleeders [ORZ1.742; 95% CI(1.062, 2.857)]. Conclusions: Our center’s data suggests that in the inpatient setting, females tend to have better bowel preparation quality than males. Addi-
AB214 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014
Patient characteristics Patient characteristics O 60 Males Caucasian African American Hispanic Asian Other Unknown/Not listed Marital status Married Narcotic use within two days prior to colonoscopy Dulcolax Adjunct laxative use (in addition to Colace Polyethylene glycol preparation) within two days prior to colonoscopy Miralax Senna Lactulose Magnesium Citrate Diet status 24hrs prior to colonoscopy Clear liquid with NPO after midnight NPO only Other Indication for Gastroenterology consult Lower GI bleeding Other Indication for colonoscopy Lower GI bleeding Other Age Gender Race
n
%
230 217 315 22 15 11 2 10 188 110 72 59 30 41 13 23 243
61.17 57.71 83.78 5.85 4.26 2.93 0.53 2.66 51.09 29.33 19.5 15.69 7.98 10.9 3.46 6.12 64.8
55 77 194 182 218 158
14.67 20.53 51.6 48.4 57.98 42.02
Su1561 Patient-Related Factors Affecting Bowel Preparation Prior to Colonoscopy Juan S. Lasa*1, Melisa T. Senderovsky1, Ignacio Fanjul1, Rafael Moore1, Guillermo Dima1, Angel D. Peralta1, Ignacio Zubiaurre1, Abel Novillo2, Luis O. Soifer1 1 Gastroenterology, CEMIC, Buenos Aires, Argentina; 2Gastroenterology, Sanatorio 9 de Julio, San Miguel de Tucumán, Argentina Background: Colonoscopy is a colorectal cancer (CRC) screening tool that allows complete exploration of colonic mucosa and the chance to resect adenomatous lesions. Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance. Much emphasis has been made on procedure-related factors influencing bowel preparation quality, such as the timing of purgative administration. There is less evidence on patient-related factors that may
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