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Measuring bowel preparation adequacy in colonoscopy-based research: review of key considerations

Published:September 27, 2019DOI:https://doi.org/10.1016/j.gie.2019.09.031
      An assessment of bowel cleanliness is an important variable in colonoscopy-based research. Bowel preparation adequacy will be the primary endpoint in any study comparing bowel purgatives, dietary manipulations in the days leading up to colonoscopy, or devices for intraprocedural washing. A recent search of ClinicalTrials.gov yielded more than 300 studies of bowel preparation for colonoscopy. Bowel preparation adequacy may also be a covariate in studies comparing other outcomes, such as rates of adenoma detection or cecal intubation. Investigators should carefully consider several factors when designing a study that will include bowel preparation adequacy as a variable.

      Abbreviations:

      BBPS (Boston Bowel Preparation Scale), OBPQS (Ottawa Bowel Preparation Quality Scale)
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      References

      1. ClinicalTrials.gov.
        (Available at:)
        • Heron V.
        • Parmar R.
        • Menard C.
        • et al.
        Validating bowel preparation scales.
        Endosc Int Open. 2017; 5: E1179-E1188
        • Parmar R.
        • Martel M.
        • Rostom A.
        • et al.
        Validated scales for colon cleansing: a systematic review.
        Am J Gastroenterol. 2016; 111: 197-204
        • Singal A.G.
        • Higgins P.D.
        • Waljee A.K.
        A primer on effectiveness and efficacy trials.
        Clin Translat Gastroenterol. 2014; 5: e45
        • Melicharkova A.
        • Flemming J.
        • Vanner S.
        • et al.
        A low-residue breakfast improves patient tolerance without impacting quality of low-volume colon cleansing prior to colonoscopy: a randomized trial.
        Am J Gastroenterol. 2013; 108: 1551-1555
        • Gu P.
        • Lew D.
        • Oh S.J.
        • et al.
        Comparing the real-world effectiveness of competing colonoscopy preparations: results of a prospective trial.
        Am J Gastroenterol. 2019; 114: 305-314
        • Johnson D.A.
        • Barkun A.N.
        • Cohen L.B.
        • et al.
        Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the U.S. multi-society task force on colorectal cancer.
        Gastrointest Endosc. 2014; 80: 543-562
        • Saltzman J.R.
        • Cash B.D.
        • Pasha S.F.
        • et al.
        • ASGE Standards of Practice Committee
        Bowel preparation before colonoscopy.
        Gastrointest Endosc. 2015; 81: 781-794
        • Ton L.
        • Lee H.
        • Taunk P.
        • et al.
        Nationwide variability of colonoscopy preparation instructions.
        Dig Dis Sci. 2014; 59: 1726-1732
        • Jones R.M.
        • Devers K.J.
        • Kuzel A.J.
        • et al.
        Patient-reported barriers to colorectal cancer screening: a mixed-methods analysis.
        Am J Prev Med. 2010; 38: 508-516
        • McLachlan S.A.
        • Clements A.
        • Austoker J.
        Patients' experiences and reported barriers to colonoscopy in the screening context—a systematic review of the literature.
        Patient Educ Couns. 2012; 86: 137-146
        • Hassan C.
        • East J.
        • Radaelli F.
        • et al.
        Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline—update 2019.
        Endoscopy. 2019; 51: 775-794
        • Nguyen D.L.
        • Jamal M.M.
        • Nguyen E.T.
        • et al.
        Low-residue versus clear liquid diet before colonoscopy: a meta-analysis of randomized, controlled trials.
        Gastrointest Endosc. 2016; 83: 499-507
        • Butt J.
        • Bunn C.
        • Paul E.
        • et al.
        The White Diet is preferred, better tolerated, and non-inferior to a clear-fluid diet for bowel preparation: a randomized controlled trial.
        J Gastroenterol Hepatol. 2016; 31: 355-363
        • Sipe B.W.
        • Fischer M.
        • Baluyut A.R.
        • et al.
        A low-residue diet improved patient satisfaction with split-dose oral sulfate solution without impairing colonic preparation.
        Gastrointest Endosc. 2013; 77: 932-936
        • Stolpman D.R.
        • Solem C.A.
        • Eastlick D.
        • et al.
        A randomized controlled trial comparing a low-residue diet versus clear liquids for colonoscopy preparation: impact on tolerance, procedure time, and adenoma detection rate.
        J Clin Gastroenterol. 2014; 48: 851-855
        • Leszczynski A.M.
        • MacArthur K.L.
        • Nelson K.P.
        • et al.
        The association among diet, dietary fiber, and bowel preparation at colonoscopy.
        Gastrointest Endosc. 2018; 88: 685-694
        • van Keulen K.E.
        • Neumann H.
        • Schattenberg J.M.
        • et al.
        A novel device for intracolonoscopy cleansing of inadequately prepared colonoscopy patients: a feasibility study.
        Endoscopy. 2019; 51: 85-92
        • Likert R.
        A technique for the measurement of attitudes.
        Arch Psychol. 1932; 140: 1-55
        • Adike A.
        • Buras M.R.
        • Gurudu S.R.
        • et al.
        Is the level of cleanliness using segmental Boston bowel preparation scale associated with a higher adenoma detection rate?.
        Ann Gastroenterol. 2018; 31: 217-223
        • Calderwood A.H.
        • Thompson K.D.
        • Schroy 3rd, P.C.
        • et al.
        Good is better than excellent: bowel preparation quality and adenoma detection rates.
        Gastrointest Endosc. 2015; 81: 691-699
        • Hayat U.
        • Lee P.J.
        • Lopez R.
        • et al.
        Online educational video improves bowel preparation and reduces the need for repeat colonoscopy within three years.
        Am J Med. 2016; 129: 1219
        • Kurlander J.E.
        • Sondhi A.R.
        • Waljee A.K.
        • et al.
        How efficacious are patient education interventions to improve bowel preparation for colonoscopy? A systematic review.
        PLoS One. 2016; 11e0164442
        • Sondhi A.R.
        • Kurlander J.E.
        • Waljee A.K.
        • et al.
        A telephone-based education program improves bowel preparation quality in patients undergoing outpatient colonoscopy.
        Gastroenterology. 2015; 148: 657-658
        • Spiegel B.M.
        • Talley J.
        • Shekelle P.
        • et al.
        Development and validation of a novel patient educational booklet to enhance colonoscopy preparation.
        Am J Gastroenterol. 2011; 106: 875-883
        • Tae J.W.
        • Lee J.C.
        • Hong S.J.
        • et al.
        Impact of patient education with cartoon visual aids on the quality of bowel preparation for colonoscopy.
        Gastrointest Endosc. 2012; 76: 804-811
        • Tian C.
        • Champlin S.
        • Mackert M.
        • et al.
        Readability, suitability, and health content assessment of web-based patient education materials on colorectal cancer screening.
        Gastrointest Endosc. 2014; 80: 284-290
        • Wang S.L.
        • Wang Q.
        • Yao J.
        • et al.
        Effect of WeChat and short message service on bowel preparation: an endoscopist-blinded, randomized controlled trial.
        Eur J Gastroenterol Hepatol. 2019; 31: 170-177
        • MacArthur K.L.
        • Leszczynski A.M.
        • Jacobson B.C.
        Enhancing bowel preparation instructions: Is the bang worth the buck, or are we stuck with the muck?.
        Gastrointest Endosc. 2017; 85: 98-100
        • O'Donnell L.J.
        • Virjee J.
        • Heaton K.W.
        Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate.
        BMJ. 1990; 300: 439-440
        • DeMicco M.P.
        • Clayton L.B.
        • Pilot J.
        • et al.
        Novel 1 L polyethylene glycol-based bowel preparation NER1006 for overall and right-sided colon cleansing: a randomized controlled phase 3 trial versus trisulfate.
        Gastrointest Endosc. 2018; 87: 677-687
        • Aronchick C.
        • Lipshultz W.
        • Wright S.
        Validation of an instrument to assess colon cleansing.
        Am J Gastroenterol. 1999; 94: 2667
        • Rostom A.
        • Jolicoeur E.
        Validation of a new scale for the assessment of bowel preparation quality.
        Gastrointest Endosc. 2004; 59: 482-486
        • Calderwood A.H.
        • Jacobson B.C.
        Comprehensive validation of the Boston Bowel Preparation Scale.
        Gastrointest Endosc. 2010; 72: 686-692
        • Calderwood A.H.
        • Schroy 3rd, P.C.
        • Lieberman D.A.
        • et al.
        Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness.
        Gastrointest Endosc. 2014; 80: 269-276
        • Lai E.J.
        • Calderwood A.H.
        • Doros G.
        • et al.
        The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research.
        Gastrointest Endosc. 2009; 69: 620-625
        • Halphen M.
        • Heresbach D.
        • Gruss H.J.
        • et al.
        Validation of the Harefield Cleansing Scale: a tool for the evaluation of bowel cleansing quality in both research and clinical practice.
        Gastrointest Endosc. 2013; 78: 121-131