Original Articles
Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia,☆☆

https://doi.org/10.1067/mge.2003.294Get rights and content

Abstract

Background: Suboptimal bowel preparation for colonoscopy can lead to missed colonic lesions. The aim of this study was to describe the impact of preparation quality on detection of suspected colonic neoplasia. Methods: Data from the Clinical Outcomes Research Initiative national endoscopic database for the period January 1, 2000 to December 31, 2001, were analyzed. Patient demographics, quality of preparation, and colonoscopy findings were abstracted from the database. Results: Overall, 93,004 colonoscopies with adequate documentation were reviewed. Preparation was adequate for 71,501 (76.9%) of these procedures. On multivariate analysis, preparation adequacy was associated with colonic lesion detection, odds ratio (OR) 1.21: 95% CI [1.16, 1.25]. Adequate preparation demonstrated a closer association with identification of “nonsignificant” lesions (polyps ≤9 mm), OR 1.23: 95% CI [1.19, 1.28], compared with “significant” lesion detection (mass lesion, polyps >9 mm), OR 1.05: 95% CI [0.98, 1.11]. Conclusions: Bowel preparation is inadequate for almost a quarter of patients undergoing colonoscopy. These results suggest that inadequate preparation quality only hinders detection of smaller lesions, while having negligible impact on detection of larger lesions. These results should be confirmed in prospective studies. (Gastrointest Endosc 2003;58:76-9.)

Section snippets

Clinical Outcomes Research Initiative database

The CORI database represents a consortium of 580 specialists in GI diseases at 88 sites in 24 states, selected to obtain a cross section of endoscopic practice in the United States. Participants use a computerized endoscopic report generator to produce all endoscopic reports. Reports contain standard elements determined by the Standards and Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE).8 The report generator produces a paper copy of the report and

Results

Data from a total of 113,272 colonoscopy procedures were recorded in the CORI database between January 1, 2000 and December 31, 2001, of which 93,004 were complete procedures (i.e., completed to cecum) with complete documentation of age, gender, preparation quality, and endoscopic findings. This latter group comprised the patient cohort for analysis.

Of the 93,004 colonoscopes with complete data, the bowel preparation was rated as adequate in 71,501 (76.9%). Overall, suspected neoplasia was

Discussion

This study addresses an important clinical question, namely, the impact of preparation adequacy on identification of suspected colonic neoplasia. The findings demonstrate that preparation adequacy primarily impacts the ability to discern smaller lesions while having negligible effect on the detection of larger lesions.

Some data exist with respect to usual rates of adequate bowel preparation for colonoscopy. The finding in the present study of adequate quality preparation in 77% of all patients

Acknowledgements

The data in this manuscript were obtained from the Clinical Research Initiative National Endoscopic Database (CORI-NED); CORI is supported by grants of the ASGE, Bard Interventional Products, AstraZeneca Pharmaceuticals, and support from National Institutes of Health (NIDDK) U01-DK57132-01.

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Reprint requests: Gavin C. Harewood, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, Charlton 8, 200 First St. SW, Rochester MN 55905.

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0016-5107/2003/$30.00 + 0

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