Cirrhosis, portal hypertension worsen bowel prep for colonoscopy

A recent study has observed poorer Boston Bowel Preparation Scale (BBPS) scores and longer cecal intubation times in patients with cirrhosis undergoing screening colonoscopy. Those who are not obese also have a lower rate of polyp detection.

In addition, “[p]ortal hypertension complications were associated with worsened preparation quality and longer cecal intubation times,” the researchers said. “Each incremental increase in MELD score lengthened cecal intubation time.”

This match-controlled retrospective study included patients with and without cirrhosis who underwent outpatient screening colonoscopies. The research team explored the effect of cirrhosis and portal hypertension complications on preparation quality and endoscopic measures. They also carried out a subgroup analysis that excluded patients with obesity.

A total of 1,464 patients with cirrhosis and matched controls were included. Patients with cirrhosis showed lower mean BBPS scores and slower cecal intubation times. A longer cecal intubation time correlated with a single point increase in the MELD score, as well as with ascites, hepatic encephalopathy, and variceal haemorrhage.

In subgroup analysis, nonobese patients had a significantly lower BBPS score and longer cecal intubation time. Polyp detection rate also decreased by 24 percent.

“These findings support a more aggressive bowel preparation strategy for patients with cirrhosis, especially patients with severe disease or portal hypertension complications,” the investigators said.