Introduction: Inadequate bowel preparation (prep) limits visualization and can results in the need for repeat endoscopy. There is no standard recommended bowel prep prior to pouchoscopy. We hypothesized that many patients with history of ileal pouch anal anastomosis (IPAA) undergoing pouchoscopy have inadequate prep. We hope that further analysis of patients with, and without, adequate prep will lead to insights informing the development of a standardize prep.
Methods: This was a retrospective review of adult patients with inflammatory bowel disease (IBD) or polyposis syndromes (PS) who underwent pouchoscopy at a tertiary referral center between June 2020-March 2022. Patient demographics, clinical characteristics, oral intake prior to pouchoscopy, recommended bowel prep, and endoscopic bowel prep were abstracted. Inadequate bowel prep was defined as “poor” or “fair” and adequate bowel prep was defined as “adequate”, “good” or “excellent” as described by the endoscopist. If the quality of the bowel prep was not described, two independent reviewers performed endoscopic photo review (DF, JK). Pouch age was defined as the time from pouch creation to time of pouchoscopy. χ2 test was used for comparative statistical analysis, a p value < 0.05 was defined as statistically significant.
Results: Fifty-six patients underwent 89 pouchoscopy evaluations, 27/56 (48%) were female. IPAA was indicated for IBD in 47 patients [43 ulcerative colitis, 4 Crohn’s disease] and 9 patients with PS. Median age at time of procedure was 43y (range 18-71y), median pouch age was 8y (range 0-36y). Twenty patients (22%) were noted to have inadequate bowel prep compared to 69 (78%) with adequate bowel prep. Table 1 compares these two groups. 17/17 (100%) of procedures done in patients with PS indication had adequate bowel prep compared to 52/72 (72%) in patients who underwent IPAA due to IBD (p=0.014). Other variables were not statistically significant. However, inadequate bowel prep was common with enema prep (9/21) and rare with large volume preps (1/15). Most PS patient used large volume prep.
Discussion: About 1 in 5 of patients with IPAA had inadequate bowel prep, all with a history of IBD. Inadequate bowel was uncommon with a large volume prep and consideration should be given to large volume prep being standard of care. Inadequate prep did not occur in PS patients, perhaps as large volume prep was commonly used by this group.
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