Abstract
Purpose. Bowel preparation for surveillance endoscopy following surgery can be impaired by suboptimal bowel function. Our study compares two groups of patients in order to evaluate the influence of colorectal resection on bowel preparation. Methods. From April 2010 to December 2011, 351 patients were enrolled in our retrospective study and divided into two homogeneous arms: resection group (RG) and control group. Surgical methods were classified as left hemicolectomy, right hemicolectomy, anterior rectal resection, and double colonic resection. Bowel cleansing was evaluated by nine skilled endoscopists using the Aronchick scale. Results. Among the 161 patients of the RG, surgery was as follows: 60 left hemicolectomies (37%), 62 right hemicolectomies (38%), and 33 anterior rectal resections (20%). Unsatisfactory bowel preparation was significantly higher in resected population (44% versus 12%; P value = 0.000). No significant difference (38% versus 31%, P value = ns) was detected in the intermediate score, which represents a fair quality of bowel preparation. Conclusions. Our study highlights how patients with previous colonic resection are at high risk for a worse bowel preparation. Currently, the intestinal cleansing carried out by 4 L PEG based preparation does not seem to be sufficient to achieve the quality parameters required for the post-resection endoscopic monitoring.
Highlights
Surgical methods were classified as left hemicolectomy, right hemicolectomy, anterior rectal resection, and double colonic resection
There are different tests for colorectal cancer (CRC) screening, colonoscopy is the most effective to rule out precancerous colonic lesions and prevent cancer, removing the adenomatous lesions during endoscopic examinations [1]
Patients who had a previous colonic resection were eligible for inclusion in the first arm named resection group (RG) (Table 1) and patients with other indications were included in the control group (CG)
Summary
There are different tests for colorectal cancer (CRC) screening, colonoscopy is the most effective to rule out precancerous colonic lesions and prevent cancer, removing the adenomatous lesions during endoscopic examinations [1]. Adequate bowel preparation (BP) is essential to properly examine the colonic mucosa [2] and to schedule correct follow-up colonoscopy intervals [3]. No bowel preparation method meets the ideal criteria for bowel cleansing before colonoscopy [6] and many different protocols have proved to be adequate [7,8,9,10]. When a localized CRC is diagnosed, surgical resection remains the mainstay of treatment and evidence suggest that a regular surveillance including colonoscopy is effective to prevent future adenomas or recurrences and to improve survival [11]. Endoscopy after resective surgery may be not so easy and effective as expected because
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