Appropriate timing of repeat colonoscopy for patients with inadequate bowel preparation: Right now or within 1 year?

Abstract

The quality of bowel preparation for colonoscopy is considered a key performance measure. 1 Inadequate bowel preparation induces low adenoma detection rate (ADR) and low cecal intubation rate for initial colonoscopy. 2 Moreover, it affects increasing costs for repeat colonoscopy, risk of post colonoscopy colorectal cancer (CRC), and long-term CRC incidence and mortality after negative colonoscopy. 2 The target benchmarks of adequate bowel preparation rate were proposed to be ≥85% by the US Multi-Society Task Force (USMSTF) 3 and ≥90% by the European Society of Gastrointestinal Endoscopy (ESGE). 2 However, inadequate bowel preparation still accounts for 20-25% of colonoscopies in practice. 3 Known risk factors of inadequate bowel preparation include age, male sex, high body mass index, constipation, diabetes mellitus, hypertension, liver cirrhosis, stroke, Parkinson's disease, spinal cord injury, inpatient status, previous colorectal resection, previous pelvic surgery, American Society of Anesthesiologists score ≥3, and the use of some medications (e.g., opioids, tricyclic antidepressants). 3 Major guidelines recommended using effective evidencebased agents such as high or low volume polyethylene glycol (PEG) based or non-PEG-based regimens, optimal timing (split-dose for all-day examination, and same-day for afternoon examination), low-fiber diet on the day before examination, and reinforced patient education by health-care professionals. 2,3 Unfortunately, there is insufficient evidence for the use of salvage strategy in patients with prior or expected inadequate bowel preparation.In this issue of Digestive Endoscopy, Pantale on S anchez et al. reported a prevalence of missed lesions in patients who underwent early repeat colonoscopy with prior inadequate bowel preparation. 4 The investigation was a post-hoc analysis of a prior multicenter randomized controlled trial (RCT). 5 The study included patients with inadequate bowel preparation, defined as a score <2 in the Boston Bowel Preparation Scale (BBPS) in any segment, in baseline colonoscopies. Main outcome measurements were ADR, advanced adenoma detection rate (AADR), serrated polyp detection rate (SPDR), and CRC detection rate in very early repeat colonoscopies. Inadequate bowel preparation in repeat

A Systematic Review of Exercise Therapy for Bowel Preparation

“…Inadequate bowel cleansing adversely affects various aspects of the colonoscopy procedure, such as prolonging CIT and reducing ADRs (Alvi et al, 2019; Zhang et al, 2021). Poor preparation quality may also increase the risk of procedural-related complications (e.g., perforation, bleeding), as well as increase healthcare costs and patient discomfort due to the need for reexamination (Hotta, 2022; Murphy et al, 2019).…”