B0372 - Endoscopic Disease Activity and Biologic Therapy Are Independent Predictors of Suboptimal Bowel Preparation in Patients With Inflammatory Bowel Disease Undergoing Colonoscopy: A Multicenter Analysis

Introduction: Optimal bowel preparation (BP) is critical for endoscopic assessment of inflammation and dysplasia in patients with inflammatory bowel disease (IBD). Comorbidities and patient-related factors have been associated with sub-optimal BP (SOBP) in the general population. Using a multicenter database, we sought to identify disease-specific characteristics that may impact the quality of BP in patients with IBD.

Methods: We conducted a retrospective analysis of adult IBD patients who underwent outpatient colonoscopies between January 2011 and October 2021 at three large academic medical centers. Patients with total colectomy or those undergoing only sigmoidoscopy were excluded. Quality of BP was documented using the Boston Bowel Preparation Scale (BBPS) or the Aronchick scale and dichotomized into “sub-optimal” (BBPS 0-5 or Aronchick “fair”, “poor”, unsatisfactory”) and “optimal” (BBPS 6-9 or Aronchick “excellent”, “good”). The primary objective was to evaluate IBD-specific factors associated with SOBP. Independent associations were calculated using multivariable backward stepwise regression models.

Results: Among a total of 1154 IBD patients [53% females, mean age 47±17 years, 58% with Crohn’s disease (CD), 40% with ulcerative colitis (UC), 23% with moderate-to-severe disease, 40% receiving biologic therapy], 23.5% (N=271) had SOBP. 69% of patients received a low-volume prep (≤2L) and 80% received it in a split-dose format. Cecal or anastomotic intubation was achieved in 94% of patients. On multivariable analysis, moderate-to-severe endoscopic disease versus mild or inactive disease was associated with a higher odds of SOBP [OR 2.34 (1.60-3.43)] whereas baseline biologic use was associated with a lower odds of SOBP [OR 0.67 (0.47-0.96)] among the overall IBD cohort. Additionally, age >65 years [OR 1.80 (1.11-2.90)] and hypertension [OR 1.73 (1.06-2.82)] predicted higher odds, and split-dose (vs single-dose) BP [OR 0.52 (0.32-0.83)] predicted a lower odds of SOBP among IBD patients (Fig 1-A). In the subgroup analysis, biologic therapy use, age >65 years, and split-dose BP were predictors of SOBP in both UC and CD subgroups, whereas stricturing phenotype predicted SOBP among the CD cohort (Fig 1- B,C).

Discussion: Endoscopic disease activity was predictive of SOBP, and biologic therapy was protective against SOBP among IBD patients. Improved inflammatory control using biologic therapies may also improve quality of BP among IBD patients undergoing colonoscopy.