Joseph Cioffi, MD1, Victoria Garland, MD1, Abdalla Khouqeer, MD1, Jenny Dave, MD, MS1, Francis Carro-Cruz, MD1, Praphopphat Adhatamsoontra, MD1, Leen Raddaoui, MD1, Marie L. Borum, MD, EdD, MPH2; 1George Washington University, Washington, DC; 2George Washington University School of Medicine and Health Sciences, Washington, DC
Introduction: Inadequate bowel prep during colorectal screening can result in decreased adenoma detection rates, need for repeat procedures, increased cost and patient stress. Importantly, body mass index (BMI) has been associated with colorectal cancer (CRC) and may be an independent risk factor for bowel prep quality. This study evaluated the effect of BMI on bowel prep quality during screening colonoscopies. Methods: An IRB approved, retrospective chart review of all patients referred for a screening colonoscopy at a university gastroenterology clinic during a 3 month period was performed. Patient age, gender, self-described ethnicity and BMI were obtained. Colonoscopy reports were assessed for Boston Bowel Prep Score (BBPS), pertinent findings and need for repeat procedure. In reports not using BPPS, prep descriptions were translated to numbers using the BBPS as a model (poor=3, fair=5, good/adequate=7, excellent=9). A final bowel prep score (BPS) was assigned to all colonoscopies. A confidential data based was created. Statistical analysis was performed with significance set at p=0.05. Results: 630 of 873 referred patients underwent a colonoscopy. There were 364 females and 266 males with mean age of 58.9 years. 316 were African American, 206 White, 31 Asian, 31 Hispanic and 46 undefined. The mean BMI was 30.1 (weight 85.5 kg, height 1.68 m). Average BPS was 7.72. Normal BMI (18.5-25) had a significantly higher BPS (7.66 vs. 7.19, p=0.005) compared to all others. Those with higher BMIs had significantly lower BPS (35-40 BMI, p=0.014; >40 BMI, p=0.004) than those with normal BMI and were more likely to need repeat colonoscopies (35-40 BMI, p=0.03; >40 BMI, p=0.01). Underweight patients (< 18.5 BM) had no significant difference in BPS (p=0.42) compared to patients with normal BMI. There was no difference in BPS based upon age (p=0.708), gender (p=0.574) or ethnicity (p=0.704). Having a >6 BPS (40.6% vs 24.8%) was associated with the detection of significantly more (p=0.002) concerning findings (ie. tubular, sessile serrated, tubulovillous adenomas). Discussion: This study supports previous speculation that BMI is associated with bowel prep quality. The results reveal that individuals with a normal BMI had better bowel prep quality compared to those with higher BMIs. Higher BPS was associated with greater detection of pre-malignant lesions. It is crucial that providers counsel all patients about the importance of bowel preparation, especially those with elevated BMI.
Disclosures: Joseph Cioffi indicated no relevant financial relationships. Victoria Garland indicated no relevant financial relationships. Abdalla Khouqeer indicated no relevant financial relationships. Jenny Dave indicated no relevant financial relationships. Francis Carro-Cruz indicated no relevant financial relationships. Praphopphat Adhatamsoontra indicated no relevant financial relationships. Leen Raddaoui indicated no relevant financial relationships. Marie Borum indicated no relevant financial relationships.