The effect of colonoscopy preparation quality on adenoma detection rates

Sherer, Eric A.; Imler, Timothy D.; Imperiale, Thomas F.

doi:10.1016/j.gie.2011.09.022

Cited by 93 publications

(64 citation statements)

References 36 publications

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“…In adjusted models, adequate preparation was predictive of detection of all polyps (OR, 1.21; 95% CI, 1.16-1.25), but not polyps greater than 9 mm and/or suspected cancer (OR, 1.5; 95% CI, 0.98-1.11). Similarly, a single-center study based at a US Veterans Aff airs Medical Center examined preparation quality and ADRs in 8800 colonoscopies performed between 2001 and 2010 ( 10 ). When comparing those examinations with an inadequate/ poor preparation ( n =829) with those with an adequate preparation ( n =5162), overall polyp detection was reduced (OR, 0.66; 95% CI, 0.56-0.83).…”

Section: Recommendationsmentioning

confidence: 99%

“…In clinical practice clinicians oft en use an imprecisely defi ned 4-point scale of excellent, good, fair, and poor. In this scheme, excellent and good are widely viewed as adequate, but some research indicates that many fair preparations in clinical practice also are adequate ( 10 ). Th e USMSTF previously recommended that clinicians could consider the preparation adequate if aft er suctioning and washing the mucosa during the procedure it was deemed adequate for the detection of lesions greater than 5 mm in size ( 59 ).…”

Section: Adequacy Of Bowel Preparation Should Be Assessed Aft Er Allmentioning

confidence: 99%

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Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Johnson

Barkun

Cohen

et al. 2014

American Journal of Gastroenterology

136

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The American Journal of GASTROENTEROLOGY PRACTICE GUIDELINESColorectal cancer (CRC) is the second leading cause of cancerrelated deaths in the United States ( 1 ). Colonoscopy can prevent CRC by the detection and removal of precancerous lesions. In addition to CRC screening and surveillance, colonoscopy is used widely for the diagnostic evaluation of symptoms and other positive CRC screening tests. Regardless of indication, the success of colonoscopy is linked closely to the adequacy of preprocedure bowel cleansing.Unfortunately, up to 20-25% of all colonoscopies are reported to have an inadequate bowel preparation ( 2,3 ). Th e reasons for this range from patient-related variables such as compliance with preparation instructions and a variety of medical conditions that make bowel cleansing more diffi cult to unit-specifi c factors (eg, extended wait times aft er scheduling of colonoscopy) ( 4 ). Adverse consequences of ineff ective bowel preparation include lower adenoma detection rates, longer procedural time, lower cecal intubation rates, increased electrocautery risk, and shorter intervals between examinations ( 3,5-7 ).Bowel preparation formulations intended for precolonoscopy cleansing are assessed based on their effi cacy, safety, and tolerability. Lack of specifi c organ toxicity is considered to be a prerequisite for bowel preparations. Between cleansing effi cacy and tolerability, however, the consequences of inadequate cleansing suggest that effi cacy should be a higher priority than tolerability. Consequently, the choice of a bowel cleansing regimen should be based on cleansing effi cacy fi rst and patient tolerability second. However, effi cacy and tolerability are closely interrelated. For example, a cleansing agent that is poorly tolerated and thus not fully ingested may not achieve an adequate cleansing.Th e goals of this consensus document are to provide expert, evidence-based recommendations for clinicians to optimize colonoscopy preparation quality and patient safety. Recommendations are provided using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) scoring system, which weighs the strength of the recommendation and the quality of the evidence ( 8 ). METHODS Search StrategyComputerized medical literature searches were conducted from January 1980 (fi rst year of approval of polyethylene glycol-electrolyte lavage solution [PEG-ELS]-based preparation by the Food and Drug Administration [FDA]) up to August 2013 using MEDLINE, PubMed EMBASE, Scopus, CENTRAL, and ISI Web of knowledge. We used a highly sensitive search strategy to identify reports of randomized controlled trials ( 9 ) with a combination of medical subject headings adapted to each database and text words related to colonoscopy and gastrointestinal agents, bowel preparation, generic name, and brand name. Th e complete search terms are available in Appendix A. Recursive searches and cross-referencing also were performed using a "similar articles" function; hand searches of articles were identifi ed aft er an i...

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Section: Recommendationsmentioning

confidence: 99%

Section: Adequacy Of Bowel Preparation Should Be Assessed Aft Er Allmentioning

confidence: 99%

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Johnson

Barkun

Cohen

et al. 2014

American Journal of Gastroenterology

136

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“…However, lack of standardization for grading the quality of preparation has hindered investigation of the impact of sub-optimal preparation 5 . For example, one study found similar ADRs in examinations with fair, good and excellent preparation, but there was no standardization in preparation quality 6 , or in whether the preparation was graded before or after clearing of the colon. Another challenge has been the lack of information regarding related variables such as withdrawal time in studies examining colon preparation 6 .…”

Section: Introductionmentioning

confidence: 99%

“…For example, one study found similar ADRs in examinations with fair, good and excellent preparation, but there was no standardization in preparation quality 6 , or in whether the preparation was graded before or after clearing of the colon. Another challenge has been the lack of information regarding related variables such as withdrawal time in studies examining colon preparation 6 . As a result, there are no clear recommendations regarding whether follow-up screening or surveillance intervals should be modified for examinations with suboptimal colon preparation.…”

Section: Introductionmentioning

confidence: 99%

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

Anderson¹,

Butterly²,

Robinson³

et al. 2014

Gastrointestinal Endoscopy

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Background The effect of colon preparation quality on adenoma detection rates (ADR) is unclear, partly due to lack of uniform colon preparation ratings in prior studies. The New Hampshire Colonoscopy Registry collects detailed data from colonoscopies statewide, using a uniform preparation quality scale after the endoscopist has cleaned the mucosa. Objective To compare the overall and proximal ADR and serrated polyp detection rates (SDR) in colonoscopies with differing levels of colon preparation quality. Design Cross-sectional. Setting New Hampshire statewide registry. Patients Patients undergoing colonoscopy. Interventions We examined colon preparation quality for 13,022 colonoscopies, graded using specific descriptions provided to endoscopists. ADR and SDR are the number of colonoscopies with at least one adenoma or serrated polyp (excluding those in the rectum/sigmoid) detected divided by the total number of colonoscopies, for the preparation categories: optimal (excellent/good), fair, and poor. Main outcome measurements Overall/proximal ADR/SDR. Results The overall detection rates in examinations with fair colon preparation (SDR: 8.9%; 95% CI, 7.4–10.7) (ADR: 27.1% 95% CI, 24.6–30.0) were similar to rates observed in colonoscopies with optimal preparations (SDR: 8.8%; 95% CI, 8.3–9.4) (ADR: 26.3%; 95% CI, 25.6–27.2). This finding was also observed for rates in the proximal colon. A logistic regression model (including withdrawal time) found that proximal ADR was statistically lower in the poor preparation category (odds ratio=0.45; 95% CI, 0.24–0.84; p<0.01) than in adequately prepped colons. Limitations Homogeneous population. Conclusions In our sample, there was no significant difference in overall or proximal ADR or SDR between colonoscopies with fair versus optimal colon preparations. Poor colonic preparations may reduce proximal ADR.

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“…Inadequate bowel preparation is related to lower adenoma detection rates, longer procedural times and an increase in costs and need for repeat exams [1][2][3][4][5] . Various bowel regimens are commercially available for pre-colonoscopy preparations [6] and each has been studied for its efficacy and tolerability.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Four Different Colonic Preps in 3595 Patients at A University Center: A Real Life Experience

Baba

Lewis

2016

Journal of Gastroenterology and Hepatology Research

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AIM: Several bowel preps are currently used for colonoscopy but only limited data are available comparing the different products. METHODS:We retrospectively reviewed all colonoscopies performed at Georgetown U. Hospital from May 2013 to May 2014. A 9-point modified Boston Bowel Preparation Scale (BBPS) was utilized (best score = 9) by experienced endoscopists. Colonoscopies without a BBPS score were excluded. seen for women vs men overall for both split-dose and day-prior dosepreps (with the exception of Moviprep ® in PD preps). Higher scores were seen for a.m. procedures but were not significant. All preps had lower scores in the right colon, regardless of being splitdose or day-prior dose. CONCLUSIONS: This real world experience in nearly 3600 patients confirms that split dosing is superior to day-prior dosing. We found women had higher BBPS scores than men but no differences were seen between morning and afternoon procedures. All preps were relatively comparable, however differences in price may be an important decision-maker. RESULTS:

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The effect of colonoscopy preparation quality on adenoma detection rates

Cited by 93 publications

References 36 publications

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

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

Comparison of Four Different Colonic Preps in 3595 Patients at A University Center: A Real Life Experience

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