Predictive factors for inadequate bowel cleansing in colon capsule endoscopy.

BACKGROUND AND AIMS: Achieving adequate bowel cleansing is of utmost importance for the efficiency of colon capsule endoscopy (CCE). However, information about predictive factors is lacking. The aim of this study was to assess the predictive factors of poor bowel cleansing in the CCE setting. METHODS: In this observational study, 126 patients who underwent CCE at two tertiary care hospitals were included between June 2017 and January 2020. Participants prepared for bowel cleansing with a 1-day clear liquid diet, a 4-L split-dose polyethylene glycol regimen and boosters with sodium phosphate, sodium amidotrizoate and meglumine amidotrizoate. Domperidone tablets and bisacodyl suppositories were administered when needed. Overall and per-segment bowel cleansing was evaluated using a CCE cleansing score. Simple and multiple logistic regression analysis were carried out to assess poor bowel cleansing and excretion rate predictors. RESULTS: Overall bowel cleansing was optimal in 53 patients (50.5%). Optimal per-segment bowel cleansing was achieved as follows: cecum (86 patients; 74.8%), transverse colon (91 patients; 81.3%), distal colon (81 patients; 75%) and rectum (64 patients; 66.7%). In the univariate analysis, elderly (OR, 1.03; 95% CI (1.01-1.076)) and constipation (OR, 3.82; 95% CI (1.50-9.71)) were associated with poor bowel cleansing. In the logistic regression analysis, constipation (OR, 3.77; 95% CI (1.43-10.0)) was associated with poor bowel cleansing. No variables were significantly associated with the CCE device excretion rate. CONCLUSION: Our results suggest that constipation is the most powerful predictor of poor bowel cleansing in the CCE setting. Tailored cleansing protocols should be recommended for these patients.

Evaluation of patient satisfaction in gastrointestinal endoscopy.

OBJECTIVE: Patient satisfaction questionnaires are a useful method for detecting opportunities for improvement on the basis of patient opinion. The aim of this study was to identify by means of a satisfaction questionnaire the main reasons for dissatisfaction in patients undergoing gastrointestinal endoscopy. PATIENTS AND METHODS: Five hundred and thirty-seven patients (age 49+/-15 years, 53% women) who attended a gastrointestinal endoscopy unit were interviewed 3 weeks after undergoing upper endoscopy or colonoscopy, using a previously translated and validated GHAA-9 questionnaire modified for use in gastrointestinal endoscopy. In each case, the overall score median and the percentage of patients who gave negative (poor or fair) appraisals on each of the seven main questions were estimated. These data were used to perform a Pareto analysis. RESULTS: The overall questionnaire score median was 29 (interquartiles 25 and 75 over 26 and 32, respectively). Negative appraisal percentages for each of the seven questions were: waiting time until the appointment, 9.3%; waiting time on the day of examination, 3.5%; explanations, 3.9%; personal manner of staff, 0.5%; personal manner of the physician, 0.6%; discomfort, 3.5%; overall rating, 1.9%. The vital few found by Pareto analysis were questions regarding waiting time for appointment and adequacy of explanations regarding procedure. These questions accounted for 61% of the total number of problems encountered by patients. CONCLUSION: Questionnaires on satisfaction or quality perceived by patients allow the most frequent causes for dissatisfaction to be identified. The main problems patients encountered were waiting time until the appointment and explanations.