Dataset Information

Prevalence of missed lesions in patients with inadequate bowel preparation through a very early repeat colonoscopy.

ABSTRACT:

Objectives

When bowel preparation (BP) is inadequate, international guidelines recommend repeating the colonoscopy within 1 year to avoid missing clinically relevant lesions. We aimed to determine the rate of missed lesions in patients with inadequate BP through a very early repeat colonoscopy with adequate BP.

Methods

Post hoc analysis was conducted using data collected from a prospective multicenter randomized clinical trial including patients with inadequate BP and then repeat colonoscopy. Inadequate BP was defined as the Boston Bowel Preparation Scale (BBPS) score <2 points in any segment. We included patients with any indication for colonoscopy. The adenoma detection rate (ADR), advanced ADR (AADR), and serrated polyp detection rate (SPDR) were calculated for index and repeat colonoscopies.

Results

Of the 651 patients with inadequate BP from the original trial, 413 (63.4%) achieved adequate BP on repeat colonoscopy. The median interval between index and repeat colonoscopies was 28 days. On repeat colonoscopy, the ADR was 45.3% (95% confidence interval [CI] 40.5-50.1%), the AADR was 10.9% (95% CI 8.1-14.3%), and the SPDR was 14.3% (95% CI 10.9-17.7%). Cancer was discovered in four patients (1%; 95% CI 0.2-2.5%). A total of 60.2% of all advanced adenoma (AA) were discovered on repeat colonoscopy. A colon segment scored BBPS = 0 had most AA (66.1%) and all four cancers.

Conclusion

Patients with inadequate BP present a high rate of AAs on repeat colonoscopy. When a colonoscopy has a colon segment score BBPS = 0, we recommend repeating the colonoscopy as soon as possible.

SUBMITTER: Pantaleon Sanchez M

PROVIDER: S-EPMC9545231 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

Prevalence of missed lesions in patients with inadequate bowel preparation through a very early repeat colonoscopy.

Pantaleón Sánchez Miguel M Gimeno Garcia Antonio-Z AZ Bernad Cabredo Belen B García-Rodríguez Ana A Frago Santiago S Nogales Oscar O Diez Redondo Pilar P Puig Ignasi I Romero Mascarell Cristina C Romero Sánchez-Miguel Ivan I Caballero Noemí N Ibañez Ines I Hernandez Negrín Domingo D Bujedo Sadornill Gema G Pérez Oltra Alicia A Pérez Berbegal Rocio R Casals Gemma G Seoane Urgorri Agustín A Riu Pons Faust F Amorós Jaume J Alvarez-Gonzalez Marco Antonio MA

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 20220408 6

<h4>Objectives</h4>When bowel preparation (BP) is inadequate, international guidelines recommend repeating the colonoscopy within 1 year to avoid missing clinically relevant lesions. We aimed to determine the rate of missed lesions in patients with inadequate BP through a very early repeat colonoscopy with adequate BP.<h4>Methods</h4>Post hoc analysis was conducted using data collected from a prospective multicenter randomized clinical trial including patients with inadequate BP and then repeat ...[more]

PMID: 35189669

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Project description:Abstract Aims Failed bowel preparation is common during colonoscopy, yet the optimal purgative regimen to use for the next attempt is unknown. The objective of this study was to compare the efficacy, tolerability, and safety of two regimens at supratherapeutic doses for use after failed bowel preparation. Methods A multi-centre phase III endoscopist blinded randomized controlled trial (NCT02976805) was conducted in patients who failed bowel preparation, using the US Multi-Society Task Force (USMSTF) definition of inability to exclude polyps >5 mm in size and requiring a shortened interval to next colonoscopy. Regimen A consisted of 15 mg of bisacodyl and 2 + 2 L of split dose polyethylene glycol electrolyte solution (PEG) and Regimen B consisted of 15 mg of bisacodyl and 4 + 2 L of split dose PEG. The primary outcome was adequate bowel preparation, defined as a Boston Bowel Preparation Scale (BBPS) total score ≥ 6 with all segment scores ≥ 2. Secondary outcomes were adequate bowel preparation using the USMSTF definition, median BBPS, adenoma detection (ADR), advanced adenoma detection (aADR), sessile serrated polyp detection (SSPDR), and cecal intubation (CIR). Adverse events were assessed at the time of the colonoscopy and 14 days later. Results Between February 2017 and December 2019, 250 subjects were screened at four academic centres in Canada, of which 195 were randomized: 96 to Regimen A and 99 to Regimen B. The mean (SD) age was 60.6 (11.4) years, 87 (45.1%) were female, and the median (IQR) total BBPS score at previous failed colonoscopy was 3 (1,4). Regimen B was not superior to Regimen A in achieving adequate bowel preparation using the BBPS definition (87.6% vs. 91.1%, p=0.45) or the USMSTF definition (85.4% vs 91.1%, p=0.24), nor was it superior with respect to the median BBPS score (7 vs 7, p=0.50), mean ADR (31.5% vs 37.8%, p=0.37), aADR (11.2% vs 18.9%, p=0.15), SSPDR (5.6% vs 8.9%, p=0.40) or CIR (92.1% vs 96.7%, p=0.19). Regimen A had a higher adherence rate (88.2% vs. 74.7%, p=0.02) and greater willingness to undergo the bowel preparation again (91.2% vs. 66.2%, p<0.001). The only serious adverse event occurred in a patient randomized to Regimen B who was admitted to hospital for vomiting after colonoscopy. Conclusions Split dose 4L PEG with 15mg of bisacodyl is highly efficacious, well tolerated, and can be used for patients who previously failed first line bowel preparations. The additional 2L of PEG in Regimen B did not improve bowel preparation and was not as well tolerated. Funding Agencies AMOSO Opportunities Grant, Pharmascence Inc.

Project description:ObjectiveColon hydrotherapy devices serve as a physiotherapeutic modality to manage colonic disorders by promoting intestinal peristalsis and enhancing gastrointestinal functionality. This study aims to assess and compare the effectiveness, safety, and tolerability of two remedial strategies for inadequate bowel preparation: colon hydrotherapy device enema and oral polyethylene glycol electrolyte powder.MethodsA retrospective analysis was performed on 109 patients who failed to adequately prepare for colonoscopy. These patients received remedial bowel preparation on the same day as their procedure, with 55 undergoing colon hydrotherapy enema and 54 receiving oral polyethylene glycol electrolyte powder. Patient satisfaction and tolerance were evaluated through telephone follow-up. Key metrics included the Boston Bowel Preparation Scale scores, preparation time, incidence of adverse reactions, and patient tolerance and satisfaction.ResultsNo significant differences were observed in baseline characteristics between groups (P > 0.05). The Boston Bowel Preparation Scale scores for the entire colon were 7 (3) in the hydrotherapy group and 6.5 (1) in the oral group (z = -2.075, P = 0.038). Notably, scores for the left colon were significantly higher in the hydrotherapy group [3 (1) vs. 2 (0), z = -5.586, P < 0.001]. The hydrotherapy group also exhibited a shorter preparation time [80 (20) min vs. 92.5 (20) min, z = -3.961, P < 0.001] and a lower incidence of adverse effects (36.4% vs. 88.9%, χ² = 32.035, P < 0.001). Patient satisfaction metrics, including re-selection rates and tolerance of side effects, were significantly higher in the hydrotherapy group.ConclusionsThe colon hydrotherapy device enema is an effective, efficient, and well-tolerated method for bowel cleansing, demonstrating a low incidence of adverse events. It is recommended as an effective and safe remedial therapy for patients with inadequate bowel preparation prior to colonoscopy.

Dataset Information

Prevalence of missed lesions in patients with inadequate bowel preparation through a very early repeat colonoscopy.

Objectives

Methods

Results

Conclusion

Publications

Prevalence of missed lesions in patients with inadequate bowel preparation through a very early repeat colonoscopy.

Similar Datasets

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