Impact of Obesity on Bowel Preparation for Colonoscopy

Background & Aims

An inadequately cleansed colon can lead to missed lesions, repeat procedures, increased cost, and complications from colonoscopy. Because obesity, with its known link to colorectal neoplasia, might be associated with inadequate bowel cleansing, we investigated the impact of increased body mass index (BMI) on quality of bowel preparation at colonoscopy.

Methods

All colonoscopy procedures performed at a tertiary referral center during a 4-month period were evaluated. Bowel preparation was assigned a unique composite outcome score that took into account a subjective bowel preparation score, earlier recommendation for follow-up colonoscopy as a result of inadequate bowel preparation, and the endoscopist's confidence in adequate evaluation of the colon. Univariate and multivariate logistic regression analyses were performed to identify the role of BMI in predicting an inadequate bowel preparation.

Results

During the study period, 1588 patients (59.1% female; mean age, 57.4 ± 0.34 years) fulfilled inclusion criteria. An abnormal BMI (≥25) was associated with an inadequate composite outcome score (P = .002). In multivariate logistic regression analyses, both BMI ≥25 (P = .04) and ≥30 (P = .006) were retained as independent predictors of inadequate bowel preparation. Each unit increase in BMI increased the likelihood of an inadequate composite outcome score by 2.1%. Additional independent predictors of inadequate preparation exponentially increased the likelihood of an inadequate composite outcome score; 7 additional risk factors identified 97.5% of overweight patients with an inadequate composite outcome score.

Conclusions

Obesity is an independent predictor of inadequate bowel preparation at colonoscopy. The presence of additional risk factors further increases the likelihood of a poorly cleansed colon.

Abbreviations used in this paper: AGA, American Gastroenterological Association, ASCRS, American Society of Colon and Rectal Cancer, ASGE, American Society of Gastrointestinal Endoscopy, BMI, body mass index, SAGES, Society of American Gastrointestinal and Endoscopic Surgeons