Adenoma detection in excellent versus good bowel preparation for colonoscopy.
Publication/Presentation Date
4-1-2015
Abstract
GOAL: To determine whether Excellent bowel cleansing is superior to Good for the detection of adenomas.
BACKGROUND: High quality colonoscopy requires Adequate bowel preparation. However, it is unknown whether adenoma detection differs between subcategories of Adequate cleansing.
STUDY: We utilized a retrospective, cross-sectional study design to obtain data about patients undergoing colonoscopy at a single university center between August 31, 2011 and September 1, 2012. Primary outcome was adenoma detection rate (ADR), the percentage of patients with ≥1 adenoma. Secondary outcomes included adenomas per colonoscopy, adenoma distribution (proximal vs. distal), and detection of advanced adenomas, sessile serrated polyps (SSP), and cancer.
RESULTS: The electronic medical record of 5113 consecutive colonoscopies with Good or Excellent preparation was queried for preparation quality, colonoscopy indication, demographics, medical history, and history of adenoma and colon cancer. Exclusion criteria were age below 18 years, inflammatory bowel disease, or familial polyposis. Adenoma detection was not superior with Excellent cleansing as compared with Good for ADR [respectively, 26% vs. 29%, odds ratio 0.97 (0.85, 1.11), P=0.618] or adenomas per colonoscopy [respectively, 0.437 vs. 0.499, incidence rate ratio (IRR) 0.98 (0.90, 1.07), P=0.705]. Excellent cleansing demonstrated superior detection of SSPs [IRR 1.66 (1.14, 2.40), P=0.008] and advanced adenomas [IRR 1.37 (1.09, 1.72), P=0.007] but not colon cancer [odds ratio 0.286 (0.083, 0.985), P=0.0474].
CONCLUSIONS: ADR is not significantly different between the Adequate subcategories of Excellent and Good. However, Excellent cleansing is associated with superior detection of advanced adenomas and SSPs. If confirmed, achieving an Excellent preparation may improve colonoscopy performance in the proximal colon where SSPs primarily occur.
Volume
49
Issue
4
First Page
313
Last Page
319
ISSN
1539-2031
Published In/Presented At
Tholey, D. M., Shelton, C. E., Francis, G., Anantharaman, A., Frankel, R. A., Shah, P., Coan, A., Hegarty, S. E., Leiby, B. E., & Kastenberg, D. M. (2015). Adenoma detection in excellent versus good bowel preparation for colonoscopy. Journal of clinical gastroenterology, 49(4), 313–319. https://doi.org/10.1097/MCG.0000000000000270
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
25494362
Department(s)
Administration and Leadership
Document Type
Article