Abstract
BackgroundThe effectiveness in surveillance colonoscopy largely depends on the quality of bowel preparation. We aimed to investigate the quality of bowel preparation segmentally and its effect on Adenoma Detection Rate (ADR) and Advanced Adenoma Detection Rate (AADR) at corresponding bowel segments.MethodsThis is a single-centered and cross-sectional study. A consecutive of 5798 patients who underwent colonoscopy examination were included. Bowel preparation was evaluated based on Bowel Bubble Scale (BBS) in general and Boston Bowel Preparation Scale (BBPS) in each segment (right side, transverse and left side of colon) and total BBPS scores. The quality of bowel preparation was correlated with ADR and AADR.ResultsFour thousand nine hundred forty colonoscopies (14,820 bowel segments) were included in the final analysis. In which 30.9% scored 3, 57.5% scored 2, 11.2% scored 1 and 0.4% scored 0 on basis of BBPS. For each score, ADR were 10.8, 7.7, 4.9 and 3.2%, respectively; whereas AADR were 4.5, 2.8,1.8 and 1.6% (P < 0.05). 36.9% of the colonoscopies showed presence of minimal bubbles and 34.3% with no bubble. For bowels without bubbles and with a large amount of bubbles, ADR were 28.3 and 20.0% respectively; and AADR were 13.3 and 7.1% respectively.ConclusionsSegmental bowels’ cleanliness and the amount of bubbles in bowels significantly affect ADR and AADR. The better the bowel preparation at each segment is and the less bubbles in the bowel there are, the higher ADR and AADR we got. We suggest repeating colonoscopy if any segment of the bowel preparation is poor, or if there is more bubbles, even if the total score of BBPS indicates good or fair bowel preparation.
Highlights
The effectiveness in surveillance colonoscopy largely depends on the quality of bowel preparation
The exclusion criteria are: 1.Patients did not receive oral bowel cleaning agent. 2.Patients whose age was under 18 years old, patients with active psychiatric illness, patients who were incompetent in giving consent, multiple comorbidities with American Society of Anaesthesiology (ASA) class 3 or more, patients on anticoagulation which preclude biopsyprocedures, incomplete demographic data, withdrawal colonoscopy time < 6 min, previous colectomy. 3.Failed completion of colonoscopy including poor bowel preparation, technical difficulty, patients intolerant to colonoscopy procedure, pathological stricture or external compression leading to failure in completion of colonoscopy
The mean age for the study population were 61.4 ± 10.3 years-old. 48.2% (2380/4940) were male and 51.8% (2560/4940) were female. 84.7% (4186/4940) of the indications of colonoscopy were for screening, surveillance and diagnostic purposes and the remnants were done for therapeutic purposes including endoscopic resection of lesions and polypectomy
Summary
The effectiveness in surveillance colonoscopy largely depends on the quality of bowel preparation. We aimed to investigate the quality of bowel preparation segmentally and its effect on Adenoma Detection Rate (ADR) and Advanced Adenoma Detection Rate (AADR) at corresponding bowel segments. Colorectal cancer is the 3rd most common cancer and the 4th leading cause of cancer-related mortality globally [1]. Surveillance colonoscopy is an important method of colorectal cancer screening. The effectiveness of adenoma detection in surveillance colonoscopy largely depends on the quality of colonoscopy [3,4,5,6,7]. There are few studies focusing on the association of individual segment of bowel preparation with ADR
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