Prevalence of missed lesions in patients with inadequate bowel preparation through a very early repeat colonoscopy

Abstract

Objectives: When bowel preparation (BP) is inadequate, international guidelines recommend repeating the colonoscopy within 1 year to avoid missing clinically relevant lesions. We aimed to determine the rate of missed lesions in patients with inadequate BP through a very early repeat colonoscopy with adequate BP.Methods: Post hoc analysis was conducted using data collected from a prospective multicenter randomized clinical trial including patients with inadequate BP and then repeat colonoscopy. Inadequate BP was defined as the Boston Bowel Preparation Scale (BBPS) score <2 points in any segment. We included patients with any indication for colonoscopy. The adenoma detection rate (ADR), advanced ADR (AADR), and serrated polyp detection rate (SPDR) were calculated for index and repeat colonoscopies.Results: Of the 651 patients with inadequate BP from the original trial, 413 (63.4%) achieved adequate BP on repeat colonoscopy. The median interval between index and repeat colonoscopies was 28 days. On repeat colonoscopy, the ADR was 45.3% (95% confidence interval [CI] 40.5-50.1%), the AADR was 10.9% (95% CI 8.1-14.3%), and the SPDR was 14.3% (95% CI 10.9-17.7%). Cancer was discovered in four patients (1%; 95% CI 0.2-2.5%). A total of 60.2% of all advanced adenoma (AA) were discovered on repeat colonoscopy. A colon segment scored BBPS = 0 had most AA (66.1%) and all four cancers. Conclusion:Patients with inadequate BP present a high rate of AAs on repeat colonoscopy. When a colonoscopy has a colon segment score BBPS = 0, we recommend repeating the colonoscopy as soon as possible.

Optimization of colonoscopy quality: Comprehensive review of the literature and future perspectives

“…While advanced adenoma detection is less affected (OR 0.74, 95% CI 0.62–0.87), proper bowel preparation remains crucial, particularly for identifying right‐sided, flat, and serrated lesions in some repeated colonoscopy studies 30 . Several studies have reported that inadequate or low‐quality bowel preparation is associated with an overall adenoma miss rate (AMR) of 40–48% during initial colonoscopies, and the advanced AMR was 10.9–27% 31–33 . Furthermore, inadequate bowel preparation may lead to prolonged procedures, more frequent repeat colonoscopies at shorter‐than‐recommended intervals, increased costs, lower CIRs, and a higher risk of electrocautery complications 24,34–37 .…”

“…30 Several studies have reported that inadequate or low-quality bowel preparation is associated with an overall adenoma miss rate (AMR) of 40-48% during initial colonoscopies, and the advanced AMR was 10.9-27%. [31][32][33] Furthermore, inadequate bowel preparation may lead to prolonged procedures, more frequent repeat colonoscopies at shorter-than-recommended intervals, increased costs, lower CIRs, and a higher risk of electrocautery complications. 24,[34][35][36][37] Subpar bowel preparation significantly impacts costs, leading to a 12% and 22% increase at university and public hospitals, respectively, as revealed in Rex et al's analysis.…”

Impact of WeChat guidance on bowel preparation for colonoscopy: a quasi-experiment study

“…Currently, various bowel preparation drugs and methods are available to improve the effectiveness of bowel preparation; however, approximately 33% of patients still exhibit poor bowel cleansing in clinical practice 3 . This reduces the lesion detection rate and delays the diagnosis and treatment of intestinal diseases 4 , 5 .…”

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

“…In this issue of Digestive Endoscopy , Pantaleón Sánchez 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 .…”

“…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.…”