Characteristics associated with suboptimal bowel preparation prior to colonoscopy: results of a national survey

Background: Inadequate bowel preparation prior to colonoscopy compromises the medical value of the procedure. The aim of this study is to explore the factors associated with pre-colonoscopy sub-optimal bowel preparation from the perspective of the physician.

Methods: Using a cross-sectional study design, we examined the role of various factors thought to be associated with sub-optimal bowel preparation as reported by a sample of practicing Gastroenterologists across the United States. We conducted a survey among active members of the American College of Gastroenterology to assess Gastroenterologists' perceptions about barriers faced by the patients in the bowel preparation process. Descriptions of factors associated with sub-optimal bowel preparation prior to screening colonoscopy were identified and described, including health conditions, patient cognitive/behavioral characteristics and medication use.

Results: Health conditions (including constipation and diabetes) and particular patient characteristics (including older age) were the most common perceived determinants of sub-optimal bowel preparation. Although some barriers to colonoscopy preparation (e.g., older age), cannot be modified, many are amenable to change through education.

Conclusions: This study indicates the potential value of a personalized approach to bowel preparation, which addresses the specific needs of an individual patient like chronic constipation and diabetes and those with poor literacy skills or poor fluency in English. Development and evaluation of educational interventions to address these factors warrants investment.