Longer Withdrawal Time Is More Important than Excellent Bowel Preparation in Colonoscopy of Adequate Bowel Preparation

May 19, 2020Digestive diseases and sciences

Longer Inspection Time Matters More than Perfect Bowel Cleaning in Colonoscopies with Adequate Preparation

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Abstract

A total of 5073 cases with adequate bowel preparation were analyzed.

Examinees with good bowel preparation (BBPS = 6, 7) had higher adenoma detection rates (ADR) and polyp detection rates (PDR) compared to those with excellent preparation (BBPS = 8, 9).
The ADR was 47.3% in the good preparation group versus 45.0% in the excellent group, with a statistically significant difference (P = 0.035).
The PDR was 73.7% for good preparation compared to 69.5% for excellent preparation, also showing a statistically significant difference (P = 0.004).
Colonoscopy withdrawal time (CWT) was significantly associated with both ADR and PDR, suggesting its importance in detection rates.
In multivariate analysis, CWT showed a positive association with ADR (OR 1.04) and PDR (OR 1.05), while BBPS did not have a significant impact.

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BACKGROUND: Adequate bowel preparation is crucial for effective screening colonoscopy. However, it is unclear whether higher bowel preparation scores correspond to beneficial effects on the adenoma and polyp detection rate (ADR and PDR) in the adequate bowel preparation group.

AIMS: This study aimed to evaluate the effects of bowel preparation, according to the Boston Bowel Preparation Scale (BBPS), and colonoscopy withdrawal time (CWT) on ADR and PDR in the adequate bowel preparation group.

METHODS: Healthy examinees between 50 and 75 years old who underwent colonoscopy between September 2015 and August 2016 were included. BBPS scores, CWT, ADR, and PDR were reviewed retrospectively. Predictors of ADR and PDR were analyzed with a generalized linear mixed model.

RESULTS: A total of 5073 cases with adequate bowel preparation (BBPS ≥ 6) were analyzed. Examinees with good (BBPS = 6, 7) and excellent (BBPS = 8, 9) bowel preparation were 1898 (37.4%) and 3175 (62.6%), respectively. Both ADR and PDR were higher in the good bowel preparation group than in the excellent bowel preparation group (ADR 47.3% vs. 45.0%, P = 0.035; PDR 73.7% vs. 69.5%, P = 0.004, respectively). In the multivariate analysis, CWT, rather than BBPS, was significantly associated with both ADR (OR 1.04; 95% CI 1.02-1.06; P < 0.001) and PDR (OR 1.05; 95% CI 1.02-1.07; P = 0.002).

CONCLUSIONS: Both ADR and PDR were lower when bowel preparation was excellent rather than good. However, CWT, not BBPS, was significantly associated with ADR and PDR in the adequate bowel preparation group. Therefore, meticulous inspection is important for high-quality colonoscopy regardless of the BBPS score in examinees with adequate bowel preparation.

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Longer Withdrawal Time Is More Important than Excellent Bowel Preparation in Colonoscopy of Adequate Bowel Preparation

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