36 Available online at www.medicinescience.org ORIGINAL ARTICLE Medicine Science 2022;11(1):36-40 Real-life risk factors of inadequate procedure prior to colonoscopy in a Turkish population Abdullah Ozgur Yeniova 1 , Giray Akgul 2 , Edinc Yenidogan 3 , Suleyman Gunay 4 1Tokat Gaziosmanpasa University, Faculty of Medicine, Department of Internal Medicine, Tokat, Turkey 2Gulhane Training and Reserach Hospital, Department of General Surgery, Ankara, Turkey 3Tokat Gaziosmanpasa University, Faculty of Medicine, Department of General Surgery, Tokat, Turkey 4Izmir Katip Celebi University Research and Training Hospital, Department of Gastroenterology, Izmir, Turkey Received 01 September 2021; Accepted 25 October 2021 Available online 23.12.2021 with doi: 10.5455/medscience.2021.08.275 Copyright@Author(s) - Available online at www.medicinescience.org Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Abstract Colonoscopy is one of the main diagnostic tools for symptoms related to the colon and colorectal cancer screening programs. Inadequate cleansing of colonoscopy leads to misdiagnosis of adenomas. It is recommended to re-evaluate ineffective colonoscopy. It is of utmost importance to predict whether the bowel is clean or not because the procedure is expensive, invasive and time- consuming. This study aimed to identify the risk factors of inadequate bowel preparation. The consecutive two hundred and fifty-three patients who were referred for colonoscopy were enrolled into the study. The demographic and clinical data were obtained using a questionnaire. Only 79.1% of colonoscopy were assessed as adequate. In the univariate analysis; adherence to protocol, older age, consuming high-fiber diet in last two days, number of days of low residue diet, consumed all laxative, consumed 1.5 L water after laxative usage, regular diet for dinner before the day of colonoscopy, amount of water consumed before the day of colonoscopy, amount of water consumed in the morning of the day of colonoscopy, fasting status in the morning of the CD, and were found significantly relevant for adequate bowel preparation. Older age, number of days of low residue diet, consuming high-fiber diet in last two days, regular diet for the dinner before the day of colonoscopy, not Consumed all laxatives were independent risk factors for inadequate colonoscopy. These factors are reversible risk factors except older age. Increasing the adherence to the protocol with education seems to improve the bowel preparation quality. Keywords: Bowel preparation, colonoscopy, colorectal cancer screening, quality Introduction Colonoscopy is an essential tool since it is used in the diagnosis of symptoms related to the colon as well as in colo-rectal cancer (CRC) screening programs. Precancerous lesions are detected and removed via colonoscopy. Endoscopic polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection prevent CRC-related deaths [1] . Accurate visualization of the colon mucosa is essential for detecting preneoplastic lesions, and it depends directly on adequate bowel preparation. Interval CRC is a newly emerging issue in the literature that defines CRC which is diagnosed between the last colonoscopy and scheduled colonoscopy [2]. The interval CRC is related to missed or ineffectively removed preneoplastic lesions [3]. Inadequate cleansing of the colon causes skipping adenomas and a high burden on the economy because ineffective colonoscopy procedures must be repeated. Inadequate bowel cleansing has been attributed to many factors. There are many studies aimed to compare different bowel preparation regimens, but there are relatively fewer studies that aimed to assess the risk factors of inadequate bowel cleansing. It is very important to predict if the bowel is clean beforehand since the procedure is expensive, invasive and time- consuming. Patients with inadequately cleansed bowels may be rescheduled before starting the procedure. This prevents the patient from unnecessary sedation and the risks of complications related to the invasive procedure. There are studies which evaluated risk factors for inadequate bowel preparation. Sociodemographic features such as age, sex and educational level were shown to be relevant as predictive factors for inadequate bowel preparation. On the other hand, family history of colorectal cancer or personal history of polyps have been associated with better quality of bowel cleansing attributed to a higher motivation. There were also other situations related *Corresponding Author: Suleyman Gunay, Izmir Katip Celebi University Research and Training Hospital, Department of Gastroenterology, Izmir, Turkey E-mail: suleyman.gunay@gmail.com Medicine Science International Medical Journal