The effect of quality of segmental bowel preparation on adenoma detection rate

Guo, Rui; Wang, Yongjun; Liu, Mo; Ge, Jun; Zhang, Lingye; Ma, Ling; Huang, Wenyu; Zhai, Huihong

doi:10.1186/s12876-019-1019-8

Cited by 34 publications

(29 citation statements)

References 24 publications

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“…Our results support a recent cross-sectional study that showed an increased ADR with BBPS 3 versus 2 in over 4900 patients [25]. Our results are compatible with high-quality studies concluding lack of ADR improvement with higher-than-adequate bowel cleansing [6,26].…”

Section: Discussionsupporting

confidence: 91%

Improved detection of colorectal adenomas by high-quality colon cleansing

et al. 2020

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Background and study aims Reliable adenoma detection requires “adequate” bowel preparation. The adenoma detection rate (ADR) was assessed in patients with high-quality (stool-free) cleansing versus adequate cleansing. Patients and methods This study was a post-hoc combined analysis of three randomized trials individually powered for cleansing quality assessment. Treatment-independent ADR was assessed versus colon cleansing quality by central readers using the Harefield Cleansing Scale (HCS) and the Boston Bowel Preparation Scale (BBPS). The number needed to treat (NNT) to find an additional patient with at least one adenoma was calculated for high-quality versus adequate-quality cleansing. Results A total of 1749 patients were included. ADR increased with high-quality versus adequate-quality cleansing: HCS grade A versus B, 39 % (94/242) versus 27 % (336/1229); NNT = 8.7; P < 0.001. ADR also increased with high-quality versus uniform adequate segmental cleansing scores: HCS grade A versus uniform segmental scores 2, 39 % (94/242) versus 26 % (97/379); NNT = 7.5; P < 0.001. ADR increased with top-quality versus adequate segmental cleansing scores: HCS uniform segmental scores 4 versus 2, 54 % (21/39) versus 26 % (97/379); NNT = 3.6; P < 0.001. ADR increased with BBPS 9 versus 6, 43 % (71/166) versus 26 % (247/950); NNT = 6.0; P < 0.001. Right colon ADR increased with top-quality versus adequate cleansing: HCS 4 versus 2, 20 % (25/122) versus 11 % (121/1117); NNT = 10.4; P < 0.001 and BBPS 3 versus 2, 15 % (42/284) versus 11 % (130/1192); NNT = 25.8; P = 0.033. Conclusions High-quality colon cleansing improves adenoma detection, and it should be a priority for bowel preparations for colonoscopy.

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Section: Discussionsupporting

confidence: 91%

Improved detection of colorectal adenomas by high-quality colon cleansing

et al. 2020

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“…[ 22 ] Several previous studies have reported an association between BBPS and adenoma detection rate. [ 23 , 24 ] The adenoma detection rate of the colonoscopist serves as the quality indicator for a screening colonoscopy. Some studies have reported no relationship between endoscopist fatigue and adenoma detection rate.…”

Section: Discussionmentioning

confidence: 99%

Cecal intubation time in screening colonoscopy

Kim¹

2021

Medicine

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The time required to intubate the cecum varies. The aim of this study was to determine whether demographic and anthropometric factors, such as body mass index (BMI), percent body fat, muscle mass, and fat mass, affect the cecal intubation time (CIT) during complete colonoscopy. A retrospective chart review of 1229 patients (aged 40–80 years) was performed. These patients underwent average-risk screening colonoscopies performed by expert gastroenterologists at Health Check-up Center, Seoul National University Bundang Hospital, during a health check-up. We collected data on age, sex, BMI, percent body fat, muscle mass, fat mass, history of prior abdominal or pelvic surgery, CIT, and bowel preparation quality (Boston Bowel Preparation Scale [BBPS] score). Of the 1229 patients, 62% were men. The mean age was 55 years, and the mean BMI was 24 kg/m 2 . The median CIT was 5 min. The patients were categorized into two groups according to CIT: easy colonoscopy (CIT ≤ 10 min) and difficult colonoscopy (CIT > 10 min). In univariate analysis, CIT was prolonged by the following factors: older age, poor bowel preparation, lower BMI, lower percent body fat, and less fat mass. Multivariate analysis showed that anthropometric indices including BMI, percent body fat, muscle mass, and fat mass were not significant factors for CIT. Older age (≥ 70 years) (odds ratio [OR]: 2.272, 95% confidence interval [CI]: 1.056–4.890, P = .036) and poor bowel preparation (BBPS score ≤ 5) (OR: 3.817, 95% CI: 1.866–7.808, P = .000) were found to be correlated with difficult colonoscopy. Our study suggests that anthropometric indices including BMI, percent body fat, muscle mass, and fat mass are not associated with significantly different CIT. Furthermore, sex and prior abdominal or pelvic surgery are not useful factors for a prolonged CIT. Older age (≥ 70 years) and poor bowel preparation (BBPS score ≤ 5) are significant variables predicting the CIT of expert gastroenterologists.

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“…Therefore, the evaluation of intestinal preparation quality should be more comprehensive and include the evaluation of bowel air bubbles. Guo et al used the bubble score as a supplement to the BBPS score to evaluate intestinal cleanliness in order to explore the detection rate of colorectal adenoma (43). They found that 65.7% of patients had bowel air bubbles that affected visual field observation, and the bowel air bubbles were negatively correlated with the detection rate of adenoma.…”

Section: Discussionmentioning

confidence: 99%

Association between anxiety, depression, and bowel air bubbles at colonoscopy: a prospective observational study

Cheng

Zhong

et al. 2021

Ann Palliat Med

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Background: Psychological illness could affect the gut transmission. However, few studies have reported on the association between anxiety and depression and bowel preparation failure at colonoscopy. Bowel air bubbles have become an indispensable index to evaluate intestinal cleanliness. The aim of the present study was to investigate whether anxiety and depression are associated with the bowel air bubbles.Methods: The present study was a prospective observational study of patients who underwent colonoscopy in our hospital. Participants received the standard bowel preparation guidance, including split-dose polyethylene glycol and a low-fiber diet 1 day before colonoscopy. The primary outcome was degree of the bowel air bubble, measured by bubble scores. Univariate and multivariate logistic regression analyses were used to verify the association between anxiety and depression and bowel air bubbles.Results: A total of 304 patients were enrolled in the present study between July 2019 and January 2020; 302 of these had complete data. The mean age was 48.74±11.73 years. Fifty six of 302 patients had anxiety.

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The effect of quality of segmental bowel preparation on adenoma detection rate

Cited by 34 publications

References 24 publications

Improved detection of colorectal adenomas by high-quality colon cleansing

Improved detection of colorectal adenomas by high-quality colon cleansing

Cecal intubation time in screening colonoscopy

Association between anxiety, depression, and bowel air bubbles at colonoscopy: a prospective observational study

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