Introduction: 

We evaluated factors that can predict the adequacy of bowel preparation in patients with chronic constipation undergoing colonoscopy.

Materials and Methods: 

We identified patients with chronic constipation who underwent anorectal manometry and at least 1 colonoscopy at 2 tertiary referral centers from 2003 to 2019. We also identified a subgroup of patients who underwent colonic transit testing through radiopaque marker testing. We determined demographic, medical, and constipation-related factors associated with poor bowel preparation and their effect on standardized quality metrics using univariate and multivariate analyses.

Results: 

We identified 274 patients with chronic constipation who underwent anorectal manometry testing. Both outlet dysfunction (prolonged balloon expulsion) and slow-transit constipation were associated with suboptimal bowel preparation. Outlet dysfunction was also associated with decreased cecal intubation rates, adenoma detection rates, and sessile serrated polyp detection rates. In multivariable analyses controlling for demographics and known factors associated with poor bowel preparation, outlet dysfunction was associated with an almost 3-fold odds of suboptimal bowel preparation [odds ratio (OR): 2.9; 95% confidence interval (CI): 1.6-5.1] and a 3-fold reduction in cecal intubation rates (OR: 0.3; 95% CI: 0.1-0.8). Among those with radiopaque marker colonic transit testing available, slow-transit constipation was associated with a >2-fold odds of suboptimal bowel preparation (OR: 2.2; 95% CI: 1.1-4.4).

Conclusions: 

Among a cohort of patients with chronic constipation undergoing colonoscopy, outlet dysfunction was associated with suboptimal bowel preparation and other quality metrics. Constipated patients with a rectal evacuation disorder may represent a subgroup of patients that could benefit from individualized strategies for better bowel preparation.

中文翻译：

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直肠排便障碍与慢性便秘患者肠道准备不良有关：两个中心的结果

介绍： 

我们评估了可以预测接受结肠镜检查的慢性便秘患者肠道准备是否充分的因素。

材料和方法： 

我们确定了 2003 年至 2019 年间在 2 个三级转诊中心接受过肛门直肠测压和至少 1 次结肠镜检查的慢性便秘患者。我们还确定了通过不透射线标记物测试接受结肠传输测试的一组患者。我们使用单变量和多变量分析确定了与肠道准备不良相关的人口、医疗和便秘相关因素及其对标准化质量指标的影响。

结果： 

我们确定了 274 名接受肛门直肠测压测试的慢性便秘患者。出口功能障碍（球囊排出时间延长）和慢传输型便秘均与肠道准备不佳有关。出口功能障碍还与盲肠插管率、腺瘤检出率和无蒂锯齿状息肉检出率降低相关。在控制人口统计学和与肠道准备不良相关的已知因素的多变量分析中，出口功能障碍与肠道准备不理想的几率几乎是 3 倍相关[优势比 (OR)：2.9；95% 置信区间 (CI)：1.6-5.1] 盲肠插管率降低 3 倍（OR：0.3；95% CI：0.1-0.8）。在那些可进行不透射线标记物结肠传输测试的患者中，慢传输型便秘与肠道准备不理想的几率>2倍相关（OR：2.2；95％CI：1.1-4.4）。

结论： 

在一组接受结肠镜检查的慢性便秘患者中，出口功能障碍与肠道准备和其他质量指标不理想有关。患有直肠排便障碍的便秘患者可能代表可以从更好的肠道准备的个体化策略中受益的患者亚组。