title: Cirrhotic Patients Have Worse Bowel Preparation at Screening Colonoscopy than Chronic Liver Disease Patients without Cirrhosis.
abstract: BACKGROUND
  Cirrhosis has been shown in small studies to be a predictor of suboptimal bowel preparation at screening colonoscopy. It has yet to be established whether patients with chronic liver disease in the absence of cirrhosis experience equally poor colon cleansing. Intestinal dysmotility related to cirrhosis might impair bowel preparation in this population more than those with chronic liver disease without cirrhosis.
  
  
  OBJECTIVE
  This study compared the quality of bowel preparation in cirrhotic and non-cirrhotic patients with chronic liver disease and determined whether this influenced polyp detection rate.
  
  
  METHODS
  A retrospective study of patients with chronic liver disease, both cirrhotic and non-cirrhotic, who underwent screening colonoscopy was performed. Patient characteristics, concomitant medication use, adequacy of bowel preparation, and the total number and types of polyps found were compared between cirrhotic and non-cirrhotic groups.
  
  
  RESULTS
  330 patients fulfilled inclusion criteria; 36% (n= 120) were cirrhotic. Cirrhotic patients had significantly worse bowel preparation scores compared with non-cirrhotics (mean 3.4 ± 1.1 vs. 3.7 ± 0.9,P= 0.003). Worse bowel preparation scores in cirrhotics vs. non-cirrhotics persisted despite controlling for age, sex, and concomitant diabetes mellitus (DM) (P= 0.0027). Among the cirrhotics, 48% had the lowest preparation scores compared with 30% of non-cirrhotics. No difference in polyp detection rate was found between cirrhotics and non-cirrhotics. Severity of cirrhosis as assessed by the MELD score did not predict worse bowel preparation.
  
  
  CONCLUSIONS
  Cirrhotics have significantly worse bowel preparation scores compared to non-cirrhotics with chronic liver disease. No correlation between MELD score and bowel preparation score was observed in the cirrhotic cohort.
authors.affiliation: NewYork-Presbyterian Hospital-Weill Cornell Medical College, Department of Internal Medicine, United States.
authors.forename: Anika K
authors.initials: AK
authors.lastname: Anam
authors.affiliation: NewYork-Presbyterian Hospital-Weill Cornell Medical College, Division of Gastroenterology and Hepatology, United States.
authors.forename: Kunal
authors.initials: K
authors.lastname: Karia
authors.affiliation: NewYork-Presbyterian Hospital-Weill Cornell Medical College, Division of Gastroenterology and Hepatology, United States.
authors.forename: Arun B
authors.initials: AB
authors.lastname: Jesudian
authors.affiliation: NewYork-Presbyterian Hospital-Weill Cornell Medical College, Division of Gastroenterology and Hepatology, United States.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Bosworth
keywords: ADR, adenoma detection rate; BMI, body mass index; CRC, colorectal cancer; DM, diabetes mellitus; HE, hepatic encephalopathy; MELD, Model for End-Stage Liver Disease; SBP, spontaneous bacterial peritonitis; SIBO, small intestinal bacterial overgrowth; bowel preparation; cirrhosis; colonoscopy; colorectal cancer screening; intestinal motility