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Suboptimal Bowel Preparation Significantly Impairs Colonoscopic Detection of Non-polypoid Colorectal Neoplasms

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Abstract

Background

It is unclear whether the quality of bowel preparation affects colonoscopic detection of non-polypoid colorectal neoplasms (NP-CRNs).

Aim

To evaluate the impact of bowel-cleansing quality on detection of NP-CRNs.

Methods

We performed a retrospective analysis of asymptomatic screening colonoscopy cases after standardized bowel preparation at an academic teaching hospital between June 2011 and May 2013. Primary outcome was a comparison of the adenoma detection rate (ADR) of non-polypoid morphology according to quality of bowel preparation. Secondary outcomes included detection prevalence of non-polypoid adenomas.

Results

Of the enrolled 6097 screening examinations, the preparation quality was rated as adequate (excellent or good) in 5224 (85.7 %), fair in 615 (10.1 %), and poor in 258 (4.2 %) patients. The prevalence of NP-CRNs was 40.5 % (1962/4847) of all CRNs. The overall ADR of non-polypoid morphology was 12.3 % (747/6097) of all colonoscopies, but it significantly differed among participating endoscopists (all P < 0.05). The ADR of non-polypoid morphology was significantly lower with fair- or poor-quality preparation, versus adequate-quality preparation (adjusted odds ratio [aOR] 0.55, 95 % confidence interval [CI] 0.41–0.75; aOR 0.49, 95 % CI 0.30–0.79, respectively). Poor-quality preparation was also associated with impaired detection of polypoid, proximal colon, and sub-centimeter adenomas (all P < 0.05).

Conclusions

Suboptimal (fair or poor) bowel preparation significantly impairs colonoscopic detection of NP-CRNs. Given that the prevalence of NP-CRNs is substantial in our average-risk screening cohort, ongoing efforts to improve the preparation quality are practically valuable in increasing the detection of NP-CRNs, thereby improving the efficacy of screening colonoscopies.

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The authors disclosed no financial relationships relevant to this article.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University School of Medicine, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-701, Korea

    Chi Hyuk Oh, Chang Kyun Lee, Jung-Wook Kim, Jae-Jun Shim & Jae Young Jang

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Correspondence to Chang Kyun Lee.

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Oh, C.H., Lee, C.K., Kim, JW. et al. Suboptimal Bowel Preparation Significantly Impairs Colonoscopic Detection of Non-polypoid Colorectal Neoplasms. Dig Dis Sci 60, 2294–2303 (2015). https://doi.org/10.1007/s10620-015-3628-6

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