Intest Res.  2015 Apr;13(2):153-159. 10.5217/ir.2015.13.2.153.

Patient Descriptions of Rectal Effluents May Help to Predict the Quality of Bowel Preparation With Photographic Examples

• So H
• Boo SJ
• Seo H
• Lee HS
• Lee H
• Park SH
• Kim KJ
• Ye BD
• Byeon JS
• Myung SJ
• Yang SK
• Kim JH
• Han S
• Yang DH

• KMID: 2284882
• DOI: http://doi.org/10.5217/ir.2015.13.2.153

Abstract

BACKGROUND/AIMS
Previous studies have suggested a weak correlation between self-reported rectal effluent status and bowel preparation quality. We aim to evaluate whether photographic examples of rectal effluents could improve the correlation between patient descriptions of rectal effluents and bowel preparation quality.
METHODS
Before colonoscopy, patients were asked to describe the nature of their last three rectal effluents. Photographic examples of rectal effluents were provided as a reference for scoring. Bowel preparation was subsequently assessed by a single endoscopist using a global preparation assessment scale. Preparation outcomes were grouped into two levels (excellent to good vs. fair to inadequate). Both univariate and multivariate logistic regression models were used to find any association between bowel preparation quality and patient characteristics.
RESULTS
A total of 138 patients completed the questionnaires. The mean age was 56.5+/-10.4 years. The mean sum of the last three rectal effluent scores was 5.9+/-2.0. Higher rectal effluent scores (odds ratio [OR], 0.82; P=0.043) and the presence of diverticula (OR, 0.16; P<0.001) were risk factors for suboptimal preparation.
CONCLUSIONS
Photographic example-guided patient descriptions of rectal effluents showed a statistically significant association with bowel preparation quality. However, clinical significance seemed to be low. The presence of diverticula was an independent predictive factor for suboptimal bowel preparation quality.

Keyword

Rectal effluent; Bowel preparation; Colonoscopy

MeSH Terms

Colonoscopy
Diverticulum
Humans
Logistic Models
Risk Factors
Surveys and Questionnaires

Figure

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  Fig. 1 Photographic examples of rectal effluent shown to patients for reference. (A) Clear liquid (score 1); (B) turbid liquid (score 2); (C) particulate liquid (score 3); (D) liquid with small amount of feces (score 4); (E) semi-solid stool (score 5).

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  Fig. 2 Box plot of the sum of the scores of the three rectal effluents between the two study groups. The box plot shows the median and range of each group. The suboptimal and optimal groups showed the same median value of 6, with ranges of 3-12 and 3-10, respectively.

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  Fig. 3 Receiver-operating-characteristic (ROC) curve for discriminating suboptimal bowel preparation status with three consecutive rectal effluent scores. The sensitivity, specificity, area under the curve, and cutoff point for suboptimal bowel preparation were 0.955, 0.202, 0.608, and 4, respectively.

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