Suboptimal Bowel Preparation Significantly Impairs Colonoscopic Detection of Non-polypoid Colorectal Neoplasms
- 256 Downloads
It is unclear whether the quality of bowel preparation affects colonoscopic detection of non-polypoid colorectal neoplasms (NP-CRNs).
To evaluate the impact of bowel-cleansing quality on detection of NP-CRNs.
We performed a retrospective analysis of asymptomatic screening colonoscopy cases after standardized bowel preparation at an academic teaching hospital between June 2011 and May 2013. Primary outcome was a comparison of the adenoma detection rate (ADR) of non-polypoid morphology according to quality of bowel preparation. Secondary outcomes included detection prevalence of non-polypoid adenomas.
Of the enrolled 6097 screening examinations, the preparation quality was rated as adequate (excellent or good) in 5224 (85.7 %), fair in 615 (10.1 %), and poor in 258 (4.2 %) patients. The prevalence of NP-CRNs was 40.5 % (1962/4847) of all CRNs. The overall ADR of non-polypoid morphology was 12.3 % (747/6097) of all colonoscopies, but it significantly differed among participating endoscopists (all P < 0.05). The ADR of non-polypoid morphology was significantly lower with fair- or poor-quality preparation, versus adequate-quality preparation (adjusted odds ratio [aOR] 0.55, 95 % confidence interval [CI] 0.41–0.75; aOR 0.49, 95 % CI 0.30–0.79, respectively). Poor-quality preparation was also associated with impaired detection of polypoid, proximal colon, and sub-centimeter adenomas (all P < 0.05).
Suboptimal (fair or poor) bowel preparation significantly impairs colonoscopic detection of NP-CRNs. Given that the prevalence of NP-CRNs is substantial in our average-risk screening cohort, ongoing efforts to improve the preparation quality are practically valuable in increasing the detection of NP-CRNs, thereby improving the efficacy of screening colonoscopies.
KeywordsBowel preparation Colonoscopy Colonic polyps Non-polypoid colorectal neoplasm Adenoma detection rate
Conflict of interest
The authors disclosed no financial relationships relevant to this article.
- 27.The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58:S3–S43.Google Scholar
- 28.Bosman FTCF, Hruban RH, Theise ND. WHO Classification of Tumours of the Digestive System. 4th ed. Berlin: Springer; 2010.Google Scholar
- 30.Anderson JC, Butterly LF, Robinson CM, Goodrich M, Weiss JE. Impact of fair bowel preparation quality on adenoma and serrated polyp detection: data from the New Hampshire Colonoscopy Registry by using a standardized preparation-quality rating. Gastrointest Endosc. 2014;80:463–470.PubMedCrossRefGoogle Scholar
- 38.Wexner SD, Beck DE, Baron TH, et al. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Gastrointest Endosc. 2006;63:894–909.PubMedCrossRefGoogle Scholar