Among 335,466 colonoscopies, fair bowel preparation was associated with a 2.56 times higher risk of death.
Adenoma detection was not significantly lower for good bowel preparation compared to excellent preparation.
Adenoma detection was significantly lower for fair bowel preparation compared to excellent preparation.
Individuals with fair or lower bowel preparation had significantly higher hazards for postcolonoscopy colorectal cancer death.
Efforts to improve bowel cleansing above fair scores may be necessary to enhance screening outcomes.
Simplified
INTRODUCTION: Adequate bowel preparation is paramount for a high-quality screening colonoscopy. Despite the importance of adequate bowel preparation, there is a lack of large studies that associated the degree of bowel preparation with long-term colorectal cancer outcomes in screening patients.
METHODS: In a large population-based screening program database in Austria, quality of bowel preparation was estimated according to the by the endoscopist (excellent, good, fair, poor, and inadequate bowel preparation). We used logistic regression to assess the influence of bowel preparation on the detection of different polyp types and the interphysician variation in bowel preparation scoring. Time-to-event analyses were performed to investigate the association of bowel preparation with (PCCRC) death.
RESULTS: A total of 335,466 colonoscopies between January 2012 and follow-up until December 2022 were eligible for the analyses. As compared with excellent bowel preparation, adenoma detection was not significantly lower for good bowel preparation (odds ratio 1.01, 95% confidence interval [CI] 0.9971-1.0329, P = 0.1023); however, adenoma detection was significantly lower in fair bowel preparation (odds ratio 0.97, 95% CI 0.9408-0.9939, P = 0.0166). Individuals who had fair or lower bowel preparation at screening colonoscopy had significantly higher hazards for PCCRC death (hazard ratio for fair bowel preparation 2.56, 95% CI 1.67-3.94, P < 0.001).
DISCUSSION: Fair bowel preparation on the Aronchick Scale was not only associated with a lower adenoma detection probability but also with increased risk of PCCRC death. Efforts should be made to increase bowel cleansing above fair scores.
Key numbers
2.56
Increase in death risk
Hazard ratio for fair bowel preparation compared to excellent.
0.97
Decrease in adenoma detection
Odds ratio for adenoma detection with fair vs. excellent preparation.
335,466
Colonoscopies analyzed
Total number of colonoscopies included in the study.
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Guarantor of the article: Monika Ferlitsch, MD. Specific author contributions: J.Z.S.: conceptualization, formal analysis, writing—original draft preparation. E.W.: writing—review and editing, data curation, methodology. L.M.R.: project administration, resources. A.K.: formal analysis. E.K.: project administration. D.P.: project administration, resources. A.D. and D.P.: project administration, resources. B.M.: project administration, resources. M.T.: writing—review and editing. M.F.: conceptualization, funding acquisition, project administration, resources, writing—review and editing. All authors approved of the final version of the manuscript. Financial support: The Main Association of Statutory Insurance Institutions, The Austrian Society for Gastroenterology and Hepatology and the Austrian Cancer Aid are supporting the Austrian quality certificate for screening colonoscopy (Qualitätszertifikat Darmkrebsvorsorge). Potential competing interests: M.T. had advised for Abbvie, Albireo, BiomX, Boehringer Ingelheim, Falk, Gilead, Genfit, Hightide, Intercept, Jannsen, MSD, Novartis, Phenex, Pliant, Regulus, Siemens, Shire, has received grants/research support from Albireo, Alnylam, Cymabay, Falk Pharma, Gilead, Intercept, MSD, Takeda, UltraGenyx, had received speakersfees form BMS, Falk Foundation, Gilead, Intercept, Madrigal, MSD, Roche, has received travel grants from AbbVie, Falk Foundation, Gilead, Intercept, Janssen, Roche, the Medical Universities of Graz and Vienna have filed patents on medical use of norUDCA and is listed as co-inventor. All other authors have no conflict of interest to declare.
