Indiana University Indianapolis, IN, United States
Jennifer K. Maratt, MD, MS1, Corey A. Siegel, MD, MS2, Michael K. Allio, 3, Douglas K. Rex, MD4, Joshua R. Korzenik, MD5 1Indiana University, Indianapolis, IN; 2Dartmouth-Hitchcock Medical Center, Lebanon, NH; 3ColonaryConcepts, LLC, Providence, RI; 4Indiana University School of Medicine, Indianapolis, IN; 5Brigham & Women's Hospital, Boston, MA
Introduction: Patients with inflammatory bowel disease (IBD) often require frequent colonoscopies for assessment of disease activity, response to therapy, and surveillance for dysplasia or neoplasia. Crohn’s disease (CD) may present unique challenges to bowel preparation for colonoscopy due to complications related to the disease, including strictures, fistulas, and prior surgery. The purpose of this systematic review was to synthesize existing studies of bowel preparation for colonoscopy in patients with CD to inform effective strategies to optimize preparation quality and experiences in this cohort.
Methods: We searched PubMed, Embase, and CINAHL to identify all studies examining bowel preparation for colonoscopy in patients with IBD. Studies were included if they comprised patients ≥18 years of age with CD and were available in full-text. Study design, geographic location, patient population, sample size, outcomes, and if applicable, bowel preparation formulations, were extracted from each study.
Results: 845 studies were identified, of which 10 met inclusion criteria. The studies were performed in the U.S. (2), Australia (1), and Europe (7) between 1993-2020. The number of CD patients analyzed in each study ranged from 44-618. 6 studies investigated bowel preparation formulations in patients with IBD, of which 3 compared outcomes between patients with and without IBD and 3 compared bowel preparations within a cohort of IBD patients. The remaining 4 studies surveyed IBD patients to assess factors related to colonoscopy including: acceptability (1), adherence (1), self-efficacy (1), and burden, embarrassment, pain, and overall satisfaction (1). Lower volume preparations were generally better tolerated by IBD patients. Acceptability of colonoscopy was poor with bowel preparation cited as the leading cause of lack of acceptability and adherence, and also the most burdensome aspect of the procedure.
Discussion: Studies of bowel preparation for colonoscopy for CD patients are limited and outcomes are largely analyzed for IBD patients as a whole (ulcerative colitis and CD) rather than CD alone. It remains unknown if specific features of CD, such as fistulas, strictures, and prior surgeries, may impact outcomes related to bowel preparation for colonoscopy in this cohort. Future studies should specifically investigate bowel preparation for patients with CD with consideration of disease activity and phenotype.
Disclosures: Jennifer Maratt indicated no relevant financial relationships. Corey Siegel: ColonaryConcepts – Patent Holder, Stockholder/Ownership Interest (excluding diversified mutual funds), Other Financial or Material Support, Founder. Michael Allio: ColonaryConcepts, LLC – Consultant. Douglas Rex: Aries Pharmaceutical – Consultant. Boston Scientific – Consultant. Braintree Laboratories – Consultant, Grant/Research Support. Endokey – Consultant. Erbe USA Inc – Grant/Research Support. GI Supply – Consultant. Medivators – Grant/Research Support. Medtronic – Consultant. Norgine – Consultant. Olympus Corporation – Consultant, Grant/Research Support. Satisfai Health – Stockholder/Ownership Interest (excluding diversified mutual funds). Joshua Korzenik: Bilayer Therapeutics – Other Financial or Material Support, Founder. ClostraBio – Consultant. ColonaryConcepts – Patent Holder, Other Financial or Material Support, Founder. Corevitas – Consultant. Pfizer – Grant/Research Support. Roche – Other Financial or Material Support, Data Safety Monitoring Board. Thetis – Consultant.
Jennifer K. Maratt, MD, MS1, Corey A. Siegel, MD, MS2, Michael K. Allio, 3, Douglas K. Rex, MD4, Joshua R. Korzenik, MD5. P0571 - Bowel Preparation for Colonoscopy in Crohn's Disease: A Systematic Review, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.