Introduction: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths amongst men and women together in the United States. Screening colonoscopies have been proven to reduce CRC mortality. However, the efficacy of colonoscopies can be hindered by poor bowel preparation due to poor visualization and a higher likelihood of missing polyps and other colonic lesions including CRC. Per ASGE, adenoma detection rate (ADR) for combined male and female population is 25%. This retrospective study aims to identify the ADR for patients with inadequate bowel preparation noted during colonoscopies at our institution to emphasize the importance of quality bowel preparation. Methods: During the years 2018-2020, a total of 250 inadequately prepared colonoscopies were examined at University of Louisville Hospital for our study. 28 colonoscopies were excluded due to being aborted prior to the procedure brown stool being present on exam. 14 colonoscopies did not have pathology reports and were also excluded. The study was a retrospective single-center cohort study reviewing risk factors in patients with inadequate bowel preparation noted during colonoscopy. A Boston Bowel Preparation Scale (BBPS) was used with score of , 6 (inadequate preparation) and $6 (adequate preparation).Results: This study specifically examined the adenomatous detection rate for patients with poor colonoscopy preparation. Of these, 27 patients with screening colonoscopy indications had adenomatous or highrisk polyps with an ADR of 10.8%. This was well below the ASGE quality indicator for ADR for screening colonoscopies. 18 non-screening colonoscopies had an ADR of 7.2%. Additionally, there was a total of 91 the patients who came back for repeat colonoscopy within a 3-year time span after having poor bowel preparation or aborted procedure initially. 2 patients were missing pathology reports and excluded. 29 patients were found to have adenomatous or high-risk polyps for a total of 32.5% of patients with repeat colonoscopy who initially had poor bowel preparation or aborted procedure. Conclusion: Having a BBPS score of 5 or less considerably decreased ADR compared to ASGE standards. It is critically important that patients who have poor bowel prep return for repeat colonoscopy due to high risk of missing adenomatous or high-risk polyps as shown by the follow-up data. ADR is far below the endoscopist expectation without adequate bowel preparation in both screening and non-screening colonoscopies.
mild portal, focal interface chronic inflammation and mild periportal fibrosis with delicate non-bridging septae, confirming a diagnosis of VBDS. The patient was treated with ursodexycholic acid and mycophenolate with significant improvement in his symptoms and liver enzymes. Discussion: VBDS has rarely been associated with sarcoidosis. The most common hepatic manifestation in sarcoidosis is hepatic granulomas. However, in this case the liver biopsy did not show any sarcoid lesions but instead showed severe ductopenia consistent with VBDS. VBDS is characterized by bile duct paucity secondary to biliary apoptosis triggered by oxidative stress, drug induced injury and down regulation of B cell lymphoma-2 proteins. Hepatic involvement in sarcoidosis should be evaluated with a liver biopsy to elucidate causes such as VBDS as it changes the therapeutic management for the patient.[3284] Figure 1. 1A: Trichrome stain of a portal tract shows delicate periportal fibrosis. The tract contains several large lumens representing the portal vein branch and a smaller hepatic artery branch.No bile duct is present. (Trichrome x20). Figure 1B: Cytokeratin 19 stain shows no specific uptake in a portal tract running diagonally in the center of the photograph. Bile ducts strongly express this cytokeratin and its absence confirms bile duct loss in this tract (CK19x20). Figure 1C: Copper stain shows frequent deposition of coarse granular material representing copper in periportal hepatocytes. Chronic compromise of biliary flow leads to build-up of copper at this location and reflect a physiologic effect of duct loss in this biopsy (rhodanine x40). Figure 1D: A small portal tract is in the center of the field. Hepatic artery (solid arrow) and portal vein (open arrow) branches are present in the absence of bile duct. Mild inflammation is seen in the portal tract and adjacent hepatic parenchyma (H&Ex20).
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