INTRODUCTION Inadequate bowel preparation (IBP) before colonoscopy remains a common problem. This meta-analysis aimed to assess the risk factors associated with IBP. METHODS We searched multiple databases for studies that assessed risk factors for IBP after adjustment and reported the data as adjusted odds ratios with 95% confidence intervals. Meta-analyses were conducted using a random-effects model, and pooled adjusted odds ratios for risk factors reported in ≥ 3 studies were constructed. RESULTS One hundred fifty-four studies with 358,257 participants were included. We analyzed 48 unique risk factors. Sociodemographic predictors of IBP were Medicaid insurance, obesity, current tobacco use, age ≥ 65 years, Black race, low education level, male sex, and unmarried status. Comorbidity-related predictors of IBP were any psychiatric disease, cirrhosis, American Society of Anesthesiologists (ASA) class ≥ 3, poor functional status, constipation, diabetes, previous abdominopelvic surgery, and hematochezia. Medication-related predictors of IBP were tricyclic antidepressants, antidepressants, opioids, nontricyclic antidepressants, and calcium channel blockers. Preparation/procedure-related predictors of IBP were brown liquid rectal effluent, any incomplete bowel preparation (BP) intake, lack of split-dose BP, increased BP-to-defecation interval, any nonadherence to dietary instructions, increased BP-to-colonoscopy interval, any BP intolerance, previous IBP, and inpatient status. Although afternoon colonoscopy was a predictor of IBP, subgroup analysis of prospective studies revealed no significant association. DISCUSSION Our meta-analysis focused on adjusted risk factors to provide precise estimates of the most important risk factors for IBP. Our findings could help develop a validated prediction model to identify high-risk patients for IBP, improve colonoscopy outcomes, reduce the need for repeat colonoscopies, and reduce associated healthcare costs.

中文翻译：

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结肠镜检查肠道准备不足的危险因素：全面的系统评价和荟萃分析。


引言 结肠镜检查前肠道准备不足 （IBP） 仍然是一个常见问题。本荟萃分析旨在评估与 IBP 相关的危险因素。方法 我们检索了多个数据库，以查找评估调整后 IBP 危险因素的研究，并将数据报告为调整后的比值比和 95% 置信区间。使用随机效应模型进行荟萃分析，并构建了 ≥ 3 项研究中报告的危险因素的合并调整比值比。结果 共纳入 154 项研究，涉及 358,257 名参与者。我们分析了 48 个独特的风险因素。IBP 的社会人口学预测因素是医疗补助保险、肥胖、当前烟草使用、年龄≥ 65 岁、黑人种族、低教育水平、男性和未婚状况。IBP 的合并症相关预测因素是任何精神疾病、肝硬化、美国麻醉医师协会 （ASA） ≥ 3 级、功能状态不佳、便秘、糖尿病、既往腹盆腔手术和便血。IBP 的药物相关预测因子是三环类抗抑郁药、抗抑郁药、阿片类药物、非三环类抗抑郁药和钙通道阻滞剂。IBP 的准备/操作相关预测因素是棕色液体直肠流出物、任何不完整的肠道准备 （BP） 摄入、缺乏分次剂量 BP、BP 到排便间隔增加、任何不遵守饮食指示、BP 到结肠镜检查间隔增加、任何 BP 不耐受、既往 IBP 和住院状态。尽管下午结肠镜检查是 IBP 的预测指标，但前瞻性研究的亚组分析显示没有显著相关性。讨论 我们的荟萃分析侧重于调整后的危险因素，以提供对 IBP 最重要危险因素的精确估计。 我们的研究结果可以帮助开发经过验证的预测模型，以识别 IBP 的高危患者，改善结肠镜检查结果，减少重复结肠镜检查的需要，并降低相关的医疗保健成本。