Use of the Boston Bowel Preparation Scale in the real world: what affects it?

INTRODUCTION The adequacy of bowel cleansing is one of the quality measures for colonoscopy, affecting security and diagnostic accuracy of the procedure. AimsandMethods: Aim: to evaluate the quality of bowel preparation in a series of consecutive exams and to determine its predictive factors. Retrospective study assessing patients that underwent colonoscopy in a tertiary hospital between 01/2016-06/2018. Boston Bowel Preparation Scale (BBPS) was used - total BBPS score ≥6 with BBPS ≥2 in each segment was considered as adequate. Afternoon procedures received split-dose preparations and patients from the Family Risk Clinic were educated by nurses. RESULTS 4872 colonoscopies were performed in 3839 patients, by 11 endoscopists. The main indications were: surveillance for neoplastic polyps/colorectal cancer (CRC) (52.0%); family history (FH) of CRC (21.9%). Inadequate bowel preparation (BBPS<6) was observed in 32.3% of colonoscopies, with BBPS ≤1 in the right colon in 26.8% of cases; 16.4% in the transverse colon, and 17.9% in the left colon. The quality of bowel preparation was significantly associated, in univariate analysis, with gender, day of the week, time slot of the exam, morning/afternoon procedure, endoscopist and FH of CRC. On logistic regression analysis, predictive factors for quality of bowel preparation were gender, day of the week, morning/afternoon procedure, endoscopist and colonoscopies performed due to FH of CRC. CONCLUSION In the real world, we confirmed gender, educational interventions and split dose regimens (adopted for the afternoon procedures) as factors influencing quality of bowel preparation. Furthermore, subjective biases/differences among endoscopists seem to influence BBPS in clinical practice.