Abstract
The success of a colonoscopy in detecting and removing pre-cancerous and cancerous lesions depends heavily on the quality of bowel preparation. Despite efforts, 20–44% of colonoscopy participants have an inadequate bowel preparation. We aimed to assess and compare risk factors for inadequate bowel preparation and for the presence of advanced colorectal neoplasms in routine screening practice. In this cross-sectional study, among 8125 participants of screening colonoscopy in Germany with a comprehensive assessment of sociodemographic factors, lifestyle and medical history, we examined factors associated with inadequate bowel preparation and with findings of advanced neoplasms using adjusted log-binomial regression models. Among the identified risk factors assessed, three factors were identified that were significantly associated with inadequate bowel preparation: age ≥ 70 years (adjusted prevalence ratios, aPR, 1.50 95%CI 1.31–1.71), smoking (aPR 1.29 95%CI 1.11–1.50) and abdominal symptoms (aPR 1.14 95%CI 1.02–1.27). The same risk factors were also associated with the prevalence of advanced neoplasms in our study (aPR 1.72, 1.62 and 1.44, respectively). The risk factors associated with inadequate bowel preparation in this study were also associated with a higher risk for advanced neoplasms. Inadequate bowel preparation for colonoscopy might lead to missed colorectal cancer (CRC) precursors and the late diagnosis of CRC. People at high risk of advanced neoplasms are in particular need of enhanced bowel preparation.
Highlights
Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the second most common cause of cancer-related death worldwide
Despite efforts to facilitate the process, 20–44% of colonoscopy participants have been reported in previous studies to have inadequate bowel preparation [6,7,8]
These same factors, which were found to be associated with inadequate bowel preparation, were found to be strongly associated with findings of advanced neoplasms among those with adequate bowel preparation, with aPR = 1.72 (95%CI 1.42–2.08), aPR = 1.62 (95%CI 1.31–2.00) and aPR = 1.44 (95%CI 1.24–1.68), for age ≥ 70 years, current smoking and abdominal symptoms, respectively
Summary
Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the second most common cause of cancer-related death worldwide. In 2018, CRC accounted for over 1.8 million incident cases and almost 900,000 deaths [1]. Colonoscopy, conducted either for primary screening or as a follow-up for fecal occult blood tests, is the gold standard in early detection of CRC. Screening colonoscopy has the potential to prevent a very large share of CRC incidence and mortality by detecting and removing precursors of the disease [2,3,4]. The ability to detect precursors strongly depends on the quality of bowel preparation, which facilitates the clear visualization of the mucosal surface [5]. Despite efforts to facilitate the process, 20–44% of colonoscopy participants have been reported in previous studies to have inadequate bowel preparation [6,7,8]
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