P3854 - Impact of Cirrhosis and Portal Hypertension on Colonoscopy Bowel Preparation

Benjamin Gow-Lee, MD¹, John Gaumnitz, MD¹, Muatassem Alsadhan, MD¹, Gauri Garg, BS², Linda Appiagyei. Amoafo, BS, MS³, Yue Zhang, PhD³, John Fang, MD¹, Eduardo Rodriguez Zarate, MD, MSc^1
1University of Utah School of Medicine, Salt Lake City, UT; ²University of Utah, Logan, UT; ³University of Utah, Salt Lake City, UT

Introduction: Adequate bowel cleansing is essential for a high-quality colonoscopy for colorectal cancer screening. Liver cirrhosis has previously been suggested as a possible risk factor for worse bowel preparation. We assessed how cirrhosis and portal hypertension complications affected bowel preparation and colonoscopy evaluation.

Methods: We retrospectively matched adults with cirrhosis undergoing outpatient colonoscopy with non-cirrhotic controls matched for age, sex, and race/ethnicity in a 1:1 ratio. We excluded patients with opioid use and constipation. We then compared Boston Bowel Preparation Scale (BBPS) scores, cecal intubation times and success rates, and polyp detection rates between patients with and without cirrhosis and assessed the effect of rising Model for End-Stage Liver Disease (MELD) scores using generalized linear regression. We also assessed the effect of portal hypertension complications including ascites, hepatic encephalopathy (HE), and variceal hemorrhage (VH) using a multivariable regression analysis.

Results: We evaluated 732 cases and 732 controls. Patients with cirrhosis had lower mean BBPS scores (7.3±1.8) than controls (7.7±1.6; p< 0.001). Cecal intubation time was 9% slower (8.2±5.5 minutes vs 7.5±5.2 minutes; p=0.01). There was no difference in successful cecal intubation rates (95.8% vs 96.8%; p=0.27) or mean polyp detection rates (2.3±3.4 vs 2.4±4.2 polyps detected; p=0.99). For each increase in MELD score by 1, the BBPS score fell by 0.02 (p=0.063) and cecal intubation time increased by 2% (p< 0.001). Polyp detection rate trended lower by 2% (p=0.064).

Portal hypertension worsened bowel preparation (Figure 1). Ascites decreased BBPS score by 0.42 points (p=0.002), increased cecal intubation time by 19% (p=0.001), and lowered polyp detection rate by 23% (p=0.008). Likewise, HE also decreased BBPS score by 0.32 points (p=0.034), increased cecal intubation time by 24% (p< 0.001), and lowered polyp detection rate by 24% (p=0.014). Both ascites and HE trended towards lowering successful cecal intubation rate. VH lengthened cecal intubation time significantly by 23% (p=0.043) but did not significantly lower BBPS, cecal intubation time, or polyp detection rates.

Discussion: Patients with cirrhosis have significantly lower BBPS scores and slower cecal intubation times that worsen with rising MELD scores. Portal hypertension complications including ascites and HE are associated with lower BBPS scores and polyp detection rates and longer cecal intubation times.



Disclosures:


Benjamin Gow-Lee, MD¹, John Gaumnitz, MD¹, Muatassem Alsadhan, MD¹, Gauri Garg, BS², Linda Appiagyei. Amoafo, BS, MS³, Yue Zhang, PhD³, John Fang, MD¹, Eduardo Rodriguez Zarate, MD, MSc¹. P3854 - Impact of Cirrhosis and Portal Hypertension on Colonoscopy Bowel Preparation, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.