Abstract

Pre-procedural anxiety may influence gastrointestinal symptom perception, bowel preparation quality, and overall endoscopic outcomes. We aimed to investigate the relationship between anxiety severity, gastric histopathological findings, and bowel preparation quality in patients undergoing endoscopic procedures. A total of 101 patients undergoing upper gastrointestinal endoscopy, colonoscopy, or combined procedures were included in this study. Anxiety levels were assessed using the Beck Anxiety Inventory (BAI) and categorized as minimal, mild, moderate, or severe. Bowel preparation quality was evaluated using the Boston Bowel Preparation Scale (BBPS). Histopathological findings from gastric biopsies were analyzed and compared with BAI scores. Demographic characteristics, prior endoscopy history, and the adequacy of pre-procedural information were also recorded. BBPS scores did not differ significantly according to demographic variables, type of endoscopic procedure, prior endoscopy history, or adequacy of information provided (all p > 0.05). However, a statistically significant difference in BBPS scores was observed among anxiety severity groups (χ² = 8.327, p = 0.040). Post hoc analysis demonstrated that patients with mild anxiety had significantly poorer bowel preparation compared with those with minimal anxiety (p = 0.024) and severe anxiety (p = 0.015). No significant differences were observed between the moderate anxiety group and other anxiety categories. Mean BBPS scores were 6.10 for minimal anxiety, 4.15 for mild anxiety, 6.67 for moderate anxiety, and 7.50 for severe anxiety. Anxiety severity showed a significant negative correlation with gastric inflammation scores, whereas no significant associations were found with other histopathological parameters. Mild anxiety was associated with significantly poorer bowel preparation quality, suggesting a non-linear relationship between anxiety severity and bowel cleansing adequacy. Identification and management of pre-procedural anxiety—particularly mild anxiety—may improve bowel preparation quality and overall procedural outcomes. Structured patient education and targeted anxiety-reduction strategies may enhance diagnostic accuracy and patient satisfaction. Further prospective studies are warranted to confirm these findings.

Key words: Anxiety, endoscopy, bowel preparation, boston bowel preparation scale