Cirrhosis and Portal Hypertension Worsen Bowel Preparation for Screening Colonoscopy.

Autor:	Gow-Lee B; Department of Internal Medicine, Spencer Fox Eccles School of Medicine., Gaumnitz J; Department of Internal Medicine, Spencer Fox Eccles School of Medicine., Alsadhan M; Department of Internal Medicine, Spencer Fox Eccles School of Medicine., Garg G; College of Social and Behavioral Sciences., Amoafo L; Division of Biostatistics, Department of Population Health Science, Spencer Fox Eccles School of Medicine., Zhang Y; Division of Epidemiology, Department of Internal Medicine, Spencer Fox Eccles School of Medicine., Fang J; Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT., Rodriguez E; Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT.
Jazyk:	angličtina
Zdroj:	Journal of clinical gastroenterology [J Clin Gastroenterol] 2024 Apr 01. Date of Electronic Publication: 2024 Apr 01.
DOI:	10.1097/MCG.0000000000001990
Abstrakt:	Background: Colonoscopy is a diagnostic and therapeutic procedure that reduces colorectal cancer incidence and mortality but requires adequate bowel cleansing for high-quality examination. Past studies have suggested cirrhosis as a risk factor for worse bowel preparation. Methods: We carried out a match-controlled retrospective study evaluating patients with and without cirrhosis who underwent outpatient screening colonoscopies to assess the effect of cirrhosis and portal hypertension complications on preparation quality and endoscopic measures. We also did a subgroup analysis excluding patients with obesity. Results: We examined 1464 patients with cirrhosis and matched controls. Cirrhotic patients had lower mean Boston Bowel Preparation Scale (BBPS) scores and slower cecal intubation times. We found a single point increase in the Model for End-stage Liver Disease (MELD) score, as well as ascites, hepatic encephalopathy, and variceal hemorrhage were all associated with a longer cecal intubation time. Subgroup analysis excluding patients with obesity again found a significantly lower BBPS score and longer cecal intubation time while also finding a 24% drop in polyp detection. Conclusions: Patients with cirrhosis have worse BBPS scores and longer cecal intubation times. Nonobese cirrhotic patients additionally have a lower polyp detection rate. Portal hypertension complications were associated with worsened preparation quality and longer cecal intubation times. Each incremental increase in MELD score lengthened cecal intubation time. These findings support a more aggressive bowel preparation strategy for patients with cirrhosis, especially patients with severe disease or portal hypertension complications. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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