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Longer Withdrawal Time Is More Important than Excellent Bowel Preparation in Colonoscopy of Adequate Bowel Preparation

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Abstract

Background

Adequate bowel preparation is crucial for effective screening colonoscopy. However, it is unclear whether higher bowel preparation scores correspond to beneficial effects on the adenoma and polyp detection rate (ADR and PDR) in the adequate bowel preparation group.

Aims

This study aimed to evaluate the effects of bowel preparation, according to the Boston Bowel Preparation Scale (BBPS), and colonoscopy withdrawal time (CWT) on ADR and PDR in the adequate bowel preparation group.

Methods

Healthy examinees between 50 and 75 years old who underwent colonoscopy between September 2015 and August 2016 were included. BBPS scores, CWT, ADR, and PDR were reviewed retrospectively. Predictors of ADR and PDR were analyzed with a generalized linear mixed model.

Results

A total of 5073 cases with adequate bowel preparation (BBPS ≥ 6) were analyzed. Examinees with good (BBPS = 6, 7) and excellent (BBPS = 8, 9) bowel preparation were 1898 (37.4%) and 3175 (62.6%), respectively. Both ADR and PDR were higher in the good bowel preparation group than in the excellent bowel preparation group (ADR 47.3% vs. 45.0%, P = 0.035; PDR 73.7% vs. 69.5%, P = 0.004, respectively). In the multivariate analysis, CWT, rather than BBPS, was significantly associated with both ADR (OR 1.04; 95% CI 1.02–1.06; P < 0.001) and PDR (OR 1.05; 95% CI 1.02–1.07; P = 0.002).

Conclusions

Both ADR and PDR were lower when bowel preparation was excellent rather than good. However, CWT, not BBPS, was significantly associated with ADR and PDR in the adequate bowel preparation group. Therefore, meticulous inspection is important for high-quality colonoscopy regardless of the BBPS score in examinees with adequate bowel preparation.

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Acknowledgment

The authors appreciate the Medical Research Collaborating Center at Seoul National University Hospital for statistical analysis and consultation.

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Authors and Affiliations

  1. Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, 39F Gangnam Finance Center 152, Teheran-ro, Gangnam-gu, Seoul, 06236, South Korea

    Ji Min Choi, Ji Yeon Seo, Jooyoung Lee, Yoo Min Han, Eun Hyo Jin, Jung Ho Bae & Joo Hyun Lim

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  1. Ji Min Choi
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Correspondence to Ji Yeon Seo.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was waived because of the retrospective nature of the study and the analysis used blinded clinical data.

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Choi, J.M., Seo, J.Y., Lee, J. et al. Longer Withdrawal Time Is More Important than Excellent Bowel Preparation in Colonoscopy of Adequate Bowel Preparation. Dig Dis Sci 66, 1168–1174 (2021). https://doi.org/10.1007/s10620-020-06321-3

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  • DOI: https://doi.org/10.1007/s10620-020-06321-3

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