The impact of fair colonoscopy preparation on colonoscopy use and adenoma miss rates in patients undergoing outpatient colonoscopy

Abstract

Background The impact of fair bowel preparation on endoscopists’ recommendations and adenoma miss rates in average-risk patients undergoing colonoscopy is unknown. Objective To assess the impact of fair bowel preparation on endoscopists’ interval colonoscopy recommendations and miss rates in colonoscopies performed within 3 years of the index colonoscopy in average-risk patients undergoing colorectal cancer screening. Design Retrospective chart review. Setting Tertiary-care center. Patients Average-risk patients undergoing index colonoscopy for colorectal cancer screening between 2004 and 2006. Intervention Colonoscopy. Main Outcome Measurements Endoscopists’ interval recommendations, adenoma miss rates. Results A total of 16,251 colonoscopy records were reviewed over a 2-year period. Of these cases, 1943 colonoscopies were performed for the sole indication of average risk or screening. Of these, fair bowel preparation was reported in 619 patients (31.9%). A repeat colonoscopy within 5 years was recommended in 70.4% of patients. The follow-up colonoscopy compliance rate within 3 years was 55.9%. Adenoma detection rates at index and follow-up colonoscopy were 20.5% and 28.2%, respectively. Of the 39 patients with follow-up colonoscopy within 3 years, the overall adenoma miss rate was 28%. Of the patients with an adenoma identified on follow-up colonoscopy, 13.6% had normal colonoscopy results on index examination. Limitations Retrospective design. Conclusion Fair bowel preparation led to a deviation from national guidelines with early repeat colonoscopy follow-up recommendations in nearly 60% of average-risk patients with normal colonoscopy results. In patients who returned for repeat colonoscopy within 3 years, the overall adenoma miss rate was 28%. Further guidelines on timing for repeat colonoscopy for fair bowel preparation are needed.

Incidence and Predictors of Inadequate Bowel Preparation before Elective Colonoscopy in Thai Patients

“…Although adequate bowel preparation was seen in 91% of patients, rate of fair colon preparation was considerably high (46%). Since recently published study has shown the detrimental effect of fair bowel preparation on the rate of missing colonic adenoma (Menees et al, 2013), our study has confirmed the existence of bowel preparation quality problem of in this region.…”

A Patient-Blinded Randomized, Controlled Trial Comparing Air Insufflation, Water Immersion, and Water Exchange During Minimally Sedated Colonoscopy

“…Th e BBPS was signifi cantly higher in the WE group than in the AI group, suggesting that WE further enhanced BBPS even in patients receiving split-dose preparation. Inadequate and fair bowel preparation had been associated with increased miss rates of adenoma detection ( 43,44 ).…”

Adenoma Detection Rate Evaluation and Quality of Colonoscopy in the Center-West Region of Brazil

“…Among them, colonoscopy stands out because of its high sensitivity; it allows complete visualization of the colonic mucosa, facilitating the detection and removal of polyps, and biopsies for cancer screening (9) . According to the 1993 United States National Polyp Study, colonoscopic polypectomy reduced the incidence of CRC by 76 to 90 percent (23) . Since 1997, the American Gastroenterological Association has recommended screening for all asymptomatic individuals, aged 50 or older, with no family history of CRC.…”

“…These individuals are in the medium-risk group (9) . Despite its obvious advantages, colonoscopy has its limitations: adequacy of intestinal preparation, risks related to sedation, the risk of perforation, the risk of missing neoplasia, and high cost (23) . For lesions smaller than 10 mm, the "miss rates" can reach 11% and the rate of inadequate colon preparation reaches 25% (5) .…”