Impact of enhanced bowel preparation on complications and prognosis following colonoscopic polypectomy

Table 1 Baseline characteristics of the study participants

Characteristic	Conventional bowel preparation group (n = 65)	Enhanced bowel preparation group (n = 65)	P value
Age (years)	55.2 ± 10.3	54.8 ± 10.5	0.82
Gender, n (%)
Male	38 (58.5)	37 (56.9)	0.85
Female	27 (41.5)	28 (43.1)
BMI (kg/m2)	24.1 ± 3.2	23.9 ± 3.1	0.78
Comorbidities, n (%)
Hypertension	15 (23.1)	14 (21.5)	0.89
Diabetes	8 (12.3)	7 (10.8)	0.81
Cardiovascular disease	5 (7.7)	4 (6.2)	0.76
Polyp characteristics
Number of polyps	1.3 ± 0.6	1.4 ± 0.5	0.42
Mean polyp size (mm)	8.2 ± 2.1	8.0 ± 2.0	0.68
Polyp type, n (%)
Adenomatous	40 (61.5)	42 (64.6)	0.72
Hyperplastic	20 (30.8)	19 (29.2)
Serrated	5 (7.7)	4 (6.2)
Previous colonoscopy, n (%)	10 (15.4)	11 (16.9)	0.85
Family history of colorectal cancer, n (%)	8 (12.3)	7 (10.8)	0.81
Current use of anticoagulants, n (%)	5 (7.7)	4 (6.2)	0.76
History of inflammatory bowel disease, n (%)	2 (3.1)	1 (1.5)	0.50

Values are presented as mean ± SD. BMI: Body mass index.

Table 2 Bowel preparation quality

Indicator	Conventional bowel preparation group (n = 65)	Enhanced bowel preparation group (n = 65)	P value
Boston bowel preparation scale score
Total score	3.1 ± 0.8	4.2 ± 0.7	< 0.001
Rectum-sigmoid	1.2 ± 0.4	1.6 ± 0.3	< 0.001
Transverse-descending	1.0 ± 0.3	1.4 ± 0.4	< 0.001
Ascending-cecum	0.9 ± 0.3	1.2 ± 0.3	< 0.001
Adequacy of the bowel preparation rate	85.0% (55/65)	92.3% (60/65)	0.04
Cecal intubation rate	90.8% (59/65)	95.4% (62/65)	0.21
Withdrawal time (min)	6.2 ± 1.2	8.1 ± 1.4	< 0.001
Adenoma detection rate	30.8% (20/65)	38.5% (25/65)	0.23
Sessile serrated lesion detection rate	5.0% (3/65)	7.7% (5/65)	0.42
Frequency of recommending an appropriate screening or surveillance interval	86.2% (56/65)	93.8% (61/65)	0.12

Table 3 Procedure-related parameters

Parameter	Conventional bowel preparation group (n = 65)	Enhanced bowel preparation group (n = 65)	P value
Operative time (min)	25.4 ± 5.2	23.1 ± 4.8	0.03
One-time complete resection rate	83.1% (54/65)	95.4% (62/65)	0.01
Intraoperative blood loss (mL)	20.3 ± 5.1	18.2 ± 4.5	0.04
Number of polyps detected	1.3 ± 0.6	1.4 ± 0.5	0.42
Mean polyp size (mm)	8.2 ± 2.1	8.0 ± 2.0	0.68
Adenoma detection rate	30.8% (20/65)	38.5% (25/65)	0.23
Sessile serrated lesion detection rate	5.0% (3/65)	7.7% (5/65)	0.42
Frequency of recommending an appropriate screening or surveillance interval	86.2% (56/65)	93.8% (61/65)	0.12
Postoperative hospital stay (days)	3.4 ± 0.8	2.1 ± 0.5	< 0.001
Time to first liquid diet (hours)	12.3 ± 2.1	10.2 ± 1.8	0.02
Postoperative pain score	3.8 ± 0.9	2.3 ± 0.7	< 0.001
Frequency of use of additional sedation during the procedure	20.0% (13/65)	10.8% (7/65)	0.12
Frequency of need for repeat colonoscopy due to inadequate preparation	10.8% (7/65)	3.1% (2/65)	0.05
Frequency of patient satisfaction with procedure	76.9% (50/65)	87.7% (57/65)	0.04

Table 4 Enhanced bowel preparation reduces complications and improves patient experience, n (%)

Complication	Conventional bowel preparation group (n = 65)	Enhanced bowel preparation group (n = 65)	P value
Total complication rate	16.9% (11/65)	5.9% (4/65)	0.05
Bleeding	11 (16.9)	1 (1.5)	0.01
Perforation	2 (3.1)	0 (0.0)	0.10
Infection	5 (7.7)	1 (1.5)	0.04
Nausea and vomiting	8 (12.3)	3 (4.6)	0.12
Abdominal pain	10 (15.4)	4 (6.2)	0.04
Abdominal distension	7 (10.8)	2 (3.1)	0.07
Need for additional sedation	5 (7.7)	2 (3.1)	0.21
Patient dissatisfaction with the preparation	9 (13.8)	3 (4.6)	0.05

Table 5 Postoperative recovery

Indicator	Conventional bowel preparation group (n = 65)	Enhanced bowel preparation group (n = 65)	P value
Postoperative hospital stay (days)	3.4 ± 0.8	2.1 ± 0.5	< 0.001
Time to first liquid diet (h)	12.3 ± 2.1	10.2 ± 1.8	0.02
Postoperative pain score	3.8 ± 0.9	2.3 ± 0.7	< 0.001
Time to the first bowel movement (h)	24.5 ± 4.2	18.3 ± 3.1	< 0.001
Postoperative fatigue score	4.2 ± 0.8	2.8 ± 0.6	< 0.001
Patient satisfaction with recovery	70.8% (46/65)	89.2% (58/65)	0.01
Postoperative nausea and vomiting	15.4% (10/65)	4.6% (3/65)	0.04
Postoperative dizziness	10.8% (7/65)	3.1% (2/65)	0.07
Postoperative urinary retention	7.7% (5/65)	1.5% (1/65)	0.05

Table 6 Pathological examination and follow-up, n (%)

Indicator	Conventional bowel preparation group (n = 65)	Enhanced bowel preparation group (n = 65)	P value
Pathological confirmation of malignancy	5 (7.7)	4 (6.2)	0.76
6-month recurrence rate	10.8% (7/65)	3.1% (2/65)	0.05
Late complications	2 (3.1)	0 (0.0)	0.10
Tumor marker levels (CA19-9)	35.2 ± 10.3	28.1 ± 8.5	0.02
Tumor marker levels (CEA)	4.8 ± 1.2	3.9 ± 0.9	0.04
Lymph node metastasis rate	12.3% (8/65)	7.7% (5/65)	0.32
Postoperative infection rate	7.7% (5/65)	3.1% (2/65)	0.10
Patient satisfaction with the pathological results	80.0% (52/65)	87.7% (57/65)	0.12

Table 7 Patient compliance and adverse reactions

Indicator	Conventional bowel preparation group (n = 65)	Enhanced bowel preparation group (n = 65)	P value
Overall compliance rate	70.8% (46/65)	89.2% (58/65)	0.01
Adherence to the medication schedule	68.0% (44/65)	84.6% (55/65)	0.02
Completion of the full bowel preparation course	65.0% (42/65)	86.2% (56/65)	0.003
Frequency of adverse drug reactions	12.3% (8/65)	4.6% (3/65)	0.04
Patient satisfaction with medication	72.3% (47/65)	87.7% (57/65)	0.02
Frequency of additional sedation required	7.7% (5/65)	3.1% (2/65)	0.21
Patient dissatisfaction with the preparation process	13.8% (9/65)	4.6% (3/65)	0.05
Frequency of nausea and vomiting	15.4% (10/65)	4.6% (3/65)	0.04
Frequency of abdominal distension	10.8% (7/65)	3.1% (2/65)	0.07