The Journal of Practical Medicine >
A predictive model for bowel preparation quality and mild adverse events in colonoscopy
Received date: 2025-07-18
Online published: 2025-10-10
Objective To construct a predictive model to explore the factors influencing bowel preparation for colonoscopy and the risks of mild adverse events during colonoscopy. Methods A total of 573 patients undergoing colonoscopy at the digestive endoscopy center of the First Affiliated Hospital of the Air Force Military Medical University from July 2021 to June 2023 were enrolled in this prospective study. The patients were divided into an adequate group (n = 112) and an inadequate group (n = 461) based on bowel preparation assessed with the Boston Intestinal Readiness Score Scale (BBPS). Again, they were divided into an occurrence group (n = 106) and a non-occurrence group (n = 467) based on minor adverse events within 30 days after colonoscopy. Multivariable logistic regression was utilized to identify independent predictors of inadequate bowel preparation and minor adverse events after colonoscopy; model discrimination was quantified with receiver-operating characteristic (ROC) curve analysis, and the derived coefficients were used to construct a clinically applicable risk-scoring system. Results The adequate group achieved a significantly higher BBPS total score than the inadequate group (P < 0.05). The 30-day cumulative incidence of minor adverse events after colonoscopy was 18.5%. Inadequate bowel preparation was associated with a markedly higher event rate (36.61%) than adequate preparation (14.10%; P < 0.05). Multivariable logistic regression identified the following independent predictors of inadequate bowel preparation: age ≥ 60 years, body-mass index ≥ 28 kg/m2, history of constipation, diabetes mellitus, concomitant calcium-channel-blocker use, and Bristol Stool Form Scale types 1 ~ 2 (all P < 0.05). ROC analysis confirmed that age, constipation history, diabetes, calcium-channel-blocker use, Bristol stool type, and their combined model were all significant predictors (P < 0.05), whereas BMI alone was not (P > 0.05). Independent risk factors for post-colonoscopy minor adverse events were age ≥ 60 years, presence of ≥ 1 comorbidity, performance of biopsy or polypectomy, and warfarin use (all P < 0.05). ROC analysis demonstrated significant predictive value for age, number of comorbidities, biopsy/polypectomy, warfarin use, and their combined model (P < 0.05). Odds ratios derived from the multivariable models were converted into weighted scores; the resulting composite risk scale ranged from 0 to 100. In the validation cohort, this combined score predicted both inadequate bowel preparation and subsequent minor adverse events (P < 0.05), with an area under the curve of 0.880 (95% CI not shown), sensitivity of 0.829, and specificity of 0.707. Conclusion Inadequate bowel preparation and post-colonoscopy minor adverse events are inter-related. Independent predictors of inadequate preparation are age ≥ 60 years, BMI ≥ 28 kg/m2, constipation, diabetes mellitus, concurrent calcium-channel-blocker use, and Bristol Stool Form Scale types 1-2. Independent predictors of minor adverse events are age ≥ 60 years, ≥ 1 comorbidity, biopsy or polypectomy, and warfarin use. Targeted preventive measures against these factors should be implemented to improve clinical outcomes.
Key words: colonoscopy; bowel preparation; minor adverse events; influencing factors; forecast
Xiaoyi CHEN , Chao WANG , Yan. NIE . A predictive model for bowel preparation quality and mild adverse events in colonoscopy[J]. The Journal of Practical Medicine, 2025 , 41(19) : 3016 -3025 . DOI: 10.3969/j.issn.1006-5725.2025.19.009
| [1] | 吴园园,赵忠艳,夏盛隆,等. 结肠镜检查患者肠道准备合格率及其影响因素[J]. 中国基层医药,2021,28(1):14-18. |
| [2] | GIMENO-GARCíA A Z, BENíTEZ-ZAFRA F, NICOLáS-PéREZ D,et al. Colon Bowel Preparation in the Era of Artificial Intelligence: Is There Potential for Enhancing Colon Bowel Cleansing?[J]. Medicina (Kaunas), 2023,59(10):1834. doi:10.3390/medicina59101834 |
| [3] | SHAUKAT A, KAHI C J, BURKE C A,et al. ACG Clinical Guidelines: Colorectal Cancer Screening 2021[J]. Am J Gastroenterol,2021,116(3):458-479. doi:10.14309/ajg.0000000000001122 |
| [4] | SEWITCH M J, AZALGARA V M, SING M F. Screening Indication Associated With Lower Likelihood of Minor Adverse Events in Patients Undergoing Outpatient Colonoscopy[J]. Gastroenterol Nurs,2018,41(2):159-164. doi:10.1097/sga.0000000000000308 |
| [5] | 杨欣,赵大梅,杨艳芹,等. 老年患者结肠镜检查前肠道准备状况及其影响因素调查[J]. 护理实践与研究,2020,17(23):15-17. |
| [6] | 李丹,郭孟然,刘海峰,等. 儿童结肠镜术前肠道准备质量的影响因素[J]. 临床儿科杂志,2020,38(6):438-442. |
| [7] | 高永祥,张晋昕. Logistic回归分析的样本量确定[J]. 循证医学,2018,18(2):122-124. |
| [8] | 刘娅,刘晓晴,杨雪凝,等. 结肠镜检查患者肠道准备失败风险预测模型的构建及验证[J]. 中华护理杂志,2024,59(9):1091-1098. |
| [9] | 中国医师协会内镜医师分会消化内镜专业委员会,中国抗癌协会肿瘤内镜学专业委员会. 中国消化内镜诊疗相关肠道准备指南(2019,上海)[J]. 中华消化内镜杂志,2019,36(7):457-469. |
| [10] | PARMAR R, MARTEL M, ROSTOM A,et al. Validated Scales for Colon Cleansing: A Systematic Review[J]. Am J Gastroenterol,2016,111(2):197-204. doi:10.1038/ajg.2015.417 |
| [11] | PAN J, XIN L, MA Y F,et al. Colonoscopy Reduces Colorectal Cancer Incidence and Mortality in Patients With Non-Malignant Findings:A Meta-Analysis[J]. Am J Gastroenterol,2016,111(3):355-365. doi:10.1038/ajg.2015.418 |
| [12] | 杨蕾,杨幼林. 结肠镜检查轻微不良事件危险因素及预防[J]. 医学综述,2020,26(4):762-765. |
| [13] | 王亚军,杨幼林. 结肠镜检查不良事件及处理方法的临床研究进展[J]. 国际消化病杂志,2019,39(5):325-328+340. |
| [14] | 荀林娟,席米娜,宋瑞梅,等. 老年患者结肠镜检查前肠道准备质量的影响因素及护理对策[J]. 临床与病理杂志,2021,41(4):860-865. |
| [15] | KO C W, RIFFLE S, SHAPIRO J A,et al. Incidence of minor complications and time lost from normal activities after screening or surveillance colonoscopy[J]. Gastrointest Endosc,2007,65(4):648-656. doi:10.1016/j.gie.2006.06.020 |
| [16] | JOHNSON D A, BARKUN A N, COHEN L B,et al. Optimizing adequacy of bowel cleansing for colonoscopy:Recommendations from the US multi-society task force on colorectal cancer[J]. Gastroenterology,2014,147(4):903-924. doi:10.1053/j.gastro.2014.07.002 |
| [17] | BAUDET J S, DIAZ-BETHENCOURT D, AVILéS J,et al. Minor adverse events of colonoscopy on ambulatory patients:The impact of moderate sedation[J]. Eur J Gastroenterol Hepatol,2009,21(6):656-661. doi:10.1097/meg.0b013e328314b7e3 |
| [18] | BINI E J, FIROOZI B, CHOUNG R J,et al.Systematic evaluation of complications related to endoscopy in a training setting: A prospective 30-day outcomes study[J]. Gastrointest Endosc,2003,57(1):8-16. doi:10.1067/mge.2003.15 |
| [19] | DE JONGE V, SINT NICOLAAS J, VAN BAALEN O,et al. The incidence of 30-day adverse events after colonoscopy among outpatients in the Netherlands[J]. Am J Gastroenterol,2012,107(6):878-884. doi:10.1038/ajg.2012.40 |
| [20] | DENIS B, GENDRE I, SAULEAU E,et al. Harms of colonoscopy in a colorectal cancer screening programme with faecal occult blood test:A population-based cohort study[J]. Dig Liver Dis,2013,45(6):474-480. doi:10.1016/j.dld.2013.01.006 |
| [21] | 陈栩槿,杨成,朱先兰,等. 结肠镜检查困难程度的患者相关因素分析[J]. 胃肠病学,2023,28(8):455-461. |
| [22] | NGUYEN D L, WIELAND M. Risk factors predictive of poor quality preparation during average risk colonoscopy screening:The importance of health literacy[J]. J Gastrointestin Liver Dis,2010,19(4):369-372. |
| [23] | MCNABB-BALTAR J, DORREEN A, DHAHAB H AL,et al. Age Is the Only Predictor of Poor Bowel Preparation in the Hospitalized Patient[J]. Can J Gastroenterol Hepatol,2016,2016:2139264. doi:10.1155/2016/2139264 |
| [24] | BORG B B, GUPTA N K, ZUCKERMAN G R,et al. Impact of obesity on bowel preparation for colonoscopy[J]. Clin Gastroenterol Hepatol,2009,7(6):670-675. doi:10.1016/j.cgh.2009.02.014 |
| [25] | 王田田,尤丽丽. 结肠镜检查前肠道准备质量影响因素的Meta分析[J]. 护理研究,2021,35(2):223-230. |
| [26] | SEO E H, KIM T O, PARK M J,et al. Optimal preparation-to-colonoscopy interval in split-dose PEG bowel preparation determines satisfactory bowel preparation quality:An observational prospective study[J]. Gastrointest Endosc,2012,75(3):583-590. doi:10.1016/j.gie.2011.09.029 |
| [27] | 梁蓉,杨支兰,闫晓晓,等. 老年患者结肠镜检查前肠道准备现状及其影响因素分析[J]. 中国护理管理,2019,19(2):182-187. |
| [28] | 张娜,徐苗苗,张亚峰,等. 结肠镜肠道准备质量受检者影响因素的Meta分析[J]. 护理研究,2023,37(6):963-969. |
| [29] | 黄鸣秋,韩丹,朱怀军,等. 临床药师参与门诊结肠镜检查患者肠道准备不充分预测因素分析及模型建立[J]. 药学与临床研究,2023,31(2):172-176. |
| [30] | MALHOTRA A, SHAH N, DEPASQUALE J,et al. Use of Bristol Stool Form Scale to predict the adequacy of bowel preparation-a prospective study[J]. Colorectal Dis,2016,18(2):200-204. doi:10.1111/codi.13084 |
| [31] | WANG C N, YANG R, HOOKEY L. Does It work in Clinical Practice? A Comparison of Colonoscopy Cleansing Effectiveness in Clinical Practice Versus Efficacy from Selected Prospective Trials[J]. J Can Assoc Gastroenterol,2020,3(3):111-119. doi:10.1093/jcag/gwy070 |
| [32] | MANTA R, TREMOLATERRA F, AREZZO A,et al. Complications during colonoscopy: Prevention,diagnosis,and management[J]. Tech Coloproctol,2015,19(9):505-513. doi:10.1007/s10151-015-1344-z |
| [33] | LEE Y C, WANG H P, CHIU H M,et al. Factors determining post-colonoscopy abdominal pain: Prospective study of screening colonoscopy in 1000 subjects[J]. J Gastroenterol Hepatol,2006,21(10):1575-1580. doi:10.1111/j.1440-1746.2006.04145.x |
| [34] | KO C W, RIFFLE S, MICHAELS L,et al. Serious complications within 30 days of screening and surveillance colonoscopy are uncommon[J]. Clin Gastroenterol Hepatol,2010,8(2):166-173. doi:10.1016/j.cgh.2009.10.007 |
| [35] | GARDEZI S A, TIBBATTS C. Improving bowel preparation for colonoscopy in a cost effective manner[J]. BMJ Qual Improv Rep,2017,6(1):u204560.w5376. doi:10.1136/bmjquality.u204560.w5376 |
| [36] | ALVAREZ-GONZALEZ M A, PANTALEON M A, FLORES-LE ROUX J A,et al. Randomized Clinical Trial: A Normocaloric Low-Fiber Diet the Day Before Colonoscopy Is the Most Effective Approach to Bowel Preparation in Colorectal Cancer Screening Colonoscopy[J]. Dis Colon Rectum,2019,62(4):491-497. doi:10.1097/dcr.0000000000001305 |
| [37] | 林铠浩,蔡伟聪,刘芳江,等. 深圳市社区居民结直肠癌高危人群肠镜检查的依从性及其影响因素[J]. 现代预防医学,2023,50(17):3168-3172. |
/
| 〈 |
|
〉 |