Quality and Patient Tolerance of Polyethylene Glycol Electrolyte Bowel Preparation in Patients with Chronic Narcotic Use: Is a 4-Liter Preparation Regimen Effective?
Bibliographic record
Abstract
Introduction: There has been a significant increase in opioid prescribing for chronic pain, now estimated to include 3% of adults in the United States. In the gastrointestinal tract, chronic opioid use results in decreased motility, increased fluid absorption, and decreased colonic blood flow. Successful colonic cleansing is imperative for proper colon cancer screening and surveillance. To date, there are no data describing the tolerance of colonic cleansing in patients receiving chronic opioids. Methods: We conducted a prospective single-blinded cohort study to assess the adequacy and tolerance of bowel preparation in patients with chronic narcotic use undergoing screening or surveillance colonoscopy. Chronic narcotic use was defined as daily opioid use for ≥5 weeks prior to colonoscopy. Prior to colonoscopy, patients answered a short questionnaire regarding their tolerance of 4 liters of polyethylene glycol electrolyte solution (Figure 1). Following colonoscopy, the quality of bowel preparation was assessed using the Ottawa bowel preparation score, completed by the endoscopist previously blinded to the patient's enrollment. Two-sample t-tests or Wilcoxon rank sum tests were used to examine group differences for continuous variables, while Chi-square or Fisher's exact tests were used for binary variables.Figure 1Results: 37 subjects were enrolled into the study (n=24 in the control group, n=13 in the chronic narcotic group) with matched demographic data between the groups (Table 1). Patients with chronic narcotic use had worse Ottawa bowel preparation scores (6.1 vs. 2.2, p=0.008) and earlier recommended interval colonoscopy (46% vs. 4%, p=0.004, OR=19.71). Chronic narcotic use neared statistical significance of increased nausea during bowel preparation (62% vs. 29% p=0.06), increased sum number of reported adverse effects (1.9 vs. 1.2, p=0.06) and overall poorer tolerance score (2.2 vs. 1.5, p=0.08) (Table 2).Table 1: Patient Demographic DataTable 2: Bowel Preparation Patient Questionnaire DataConclusion: Patients receiving chronic narcotics represent a growing patient population undergoing colonoscopy. Chronic narcotic use results in poorer bowel preparation and shorter recommended interval colonoscopy, and may be associated with poorer preparation tolerance. As a result, chronic narcotic use may lead to increased cumulative procedural risk and increased cost for colorectal cancer prevention. Based on these findings, further investigation of a tolerable and effective bowel preparation regimen for patients receiving chronic narcotics is warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".