Clin Endosc.  2012 Nov;45(4):404-411.

The Effect of the Bowel Preparation Status on the Risk of Missing Polyp and Adenoma during Screening Colonoscopy: A Tandem Colonoscopic Study

• Hong SN
• Sung IK
• Kim JH
• Choe WH
• Kim BK
• Ko SY
• Lee JH
• Seol DC
• Ahn SY
• Lee SY
• Park HS
• Shim CS

Abstract

BACKGROUND/AIMS
Although a small amount of fecal material can obscure significant colorectal lesions, it has not been well documented whether bowel preparation status affects the missing risk of colorectal polyps and adenomas during a colonoscopy.
METHODS
We prospectively enrolled patients with one to nine colorectal polyps and at least one adenoma of >5 mm in size at the screening colonoscopy. Tandem colonoscopy with polypectomy was carried out within 3 months.
RESULTS
A total of 277 patients with 942 polyps and 714 adenomas completed index and tandem examinations. At the index colonoscopy, 187 polyps (19.9%) and 127 adenomas (17.8%) were missed. The per-patient miss rate of polyps and adenomas increased significantly as the bowel cleansing rate declined from excellent to poor/inadequate on the Aronchick scale (polyps, p=0.024; adenomas, p=0.040). The patients with poor/inadequate bowel preparation were independently associated with an increased risk of having missed polyps (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.13 to 9.15) or missed adenomas (OR, 3.04; 95% CI, 1.04 to 8.88) compared to the patients with excellent bowel preparation.
CONCLUSIONS
The risk of missing polyps and adenomas during screening colonoscopy is significantly affected by bowel preparation status. It seems appropriate to shorten the colonoscopy follow-up interval for patients with suboptimal bowel preparation.

Keyword

Bowel preparation; Polyp miss rate; Adenoma miss rate; Colonoscopy; Surveillance

MeSH Terms

Adenoma
Colonoscopy
Humans
Mass Screening
Polyps
Prospective Studies

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