Ju Seok Kim1, Sun Hyung Kang2, Hee Seok Moon1, Eaum Seok Lee1, Seok Hyun Kim1, Jae Kyu Sung1, Byung Seok Lee1, Hyun Yong Jeong1, Woo Suk Chung3. 1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea. 2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea. porrtos@hanmail.net. 3. Department of Anesthesiology and Pain Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
Abstract
BACKGROUND: All present guidelines regarding surveillance intervals after index colonoscopy are based on optimal bowel preparation. However, the appropriate timing of repeat colonoscopy after suboptimal bowel preparation is not clear. AIMS: To determine the appropriate timing of repeat colonoscopy following index colonoscopy with suboptimal bowel preparation. METHODS: The medical records of patients who underwent colonoscopy over 5 years were retrospectively analyzed. Index colonoscopy was defined as the first colonoscopy in patients who underwent the procedure at least twice during the study period. Bowel preparation quality was classified as optimal, fair, or poor. RESULTS: The overall adenoma detection rate was 39.1% (95% confidence interval [CI], 38.0-40.1%), but the detection rate depended significantly on bowel preparation quality (p < 0.001). The adenoma miss rate (AMR) was significant after poor (69.6%) than after optimal (27.3%) and fair (48.1%) preparation (p < 0.001). At surveillance intervals ≤2 years, the odds ratio (OR) for AMR was significantly higher for poor (OR 6.25; 95% CI, 3.76-11.83) and fair (OR 3.67; 95% CI, 2.19-6.16) preparation relative to optimal preparation; however, no difference was observed at surveillance intervals >2 years. CONCLUSIONS: Bowel preparation quality significantly affects AMR. Colonoscopy should be repeated within 2 years in patients with suboptimal bowel preparation at index colonoscopy.
BACKGROUND: All present guidelines regarding surveillance intervals after index colonoscopy are based on optimal bowel preparation. However, the appropriate timing of repeat colonoscopy after suboptimal bowel preparation is not clear. AIMS: To determine the appropriate timing of repeat colonoscopy following index colonoscopy with suboptimal bowel preparation. METHODS: The medical records of patients who underwent colonoscopy over 5 years were retrospectively analyzed. Index colonoscopy was defined as the first colonoscopy in patients who underwent the procedure at least twice during the study period. Bowel preparation quality was classified as optimal, fair, or poor. RESULTS: The overall adenoma detection rate was 39.1% (95% confidence interval [CI], 38.0-40.1%), but the detection rate depended significantly on bowel preparation quality (p < 0.001). The adenoma miss rate (AMR) was significant after poor (69.6%) than after optimal (27.3%) and fair (48.1%) preparation (p < 0.001). At surveillance intervals ≤2 years, the odds ratio (OR) for AMR was significantly higher for poor (OR 6.25; 95% CI, 3.76-11.83) and fair (OR 3.67; 95% CI, 2.19-6.16) preparation relative to optimal preparation; however, no difference was observed at surveillance intervals >2 years. CONCLUSIONS: Bowel preparation quality significantly affects AMR. Colonoscopy should be repeated within 2 years in patients with suboptimal bowel preparation at index colonoscopy.
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