Introduction Achieving key quality indicators of colonoscopy are recognised to be associated with quality of bowel cleansing.1 However, the impact of bowel preparation quality on colorectal cancer (CRC) detection and associated mortality rates is unclear. Limited published studies report conflicting results correlating detection of pre-malignant lesions with quality of bowel preparation and do not report on colorectal mortality.2 Current guidelines suggest that if bowel preparation is poor, colonoscopy should be repeated within 1 year.3 Aim: To determine the prevalence of poor bowel preparation in patients achieving complete colonoscopy, and its association with polyp detection, CRC, and mortality rates within a large district general hospital.
Methods All patients with poor bowel preparation (Boston Bowel Preparation Scale <5) undergoing colonoscopy by a single endoscopist were identified using the UNISOFT database over 5 years (2006–2010). Electronic records were analysed to identify indication for colonoscopy, completion rates, adenoma detection rate (ADR), diagnosis, 1 and 5 year mortality rates, and number of repeat colonoscopies/completion CT colonography.
Results 990 colonoscopies were performed (ADR 26%). 208/990 (21%) had poor bowel preparation (M:F 103:105, mean age 62 years). Of these, 197/208 (95%) had complete colonoscopy to the terminal ileum, caecum or anastomosis and 51/208 (25%) underwent repeat colonoscopy/CT colonography. 86/208 (41%) had indications of anaemia, previous polyps, previous CRC and abnormal imaging. Of these, 9% (n = 8/86) were found to have CRC. There was a 3/86 (3.5%) 1 year mortality rate, and 24/86 (28%) 5 year mortality rate, none from CRC. In a comparison group with the same indications for colonoscopy and good bowel preparation (n = 69), 1 and 5 year mortality rates were 2.9% (2/69) and 7.3% (n = 5/69), respectively, 1 of which resulted from CRC.
Conclusion The quality of bowel preparation does not significantly impact on CRC detection or mortality rates if complete colonoscopy examination is achieved. Early repeat colonoscopy/CT colonography within 1 year may not be necessary and subsequent examination could be at the standard recommended surveillance interval.
References 1 Hassan, et al. Bowel preparation for colonoscopy: ESGE Guideline. Endoscopy 2013;45:142–150.
2 Wong, et al. Determinants of Bowel Preparation Quality and Its Association With Adenoma Detection. Medicine (Baltimore) 2016;95(2).
3 Lieberman, et al. 2012. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the us multi-society task force on colorectal cancer. Gastroenterology 143(3):844–57.
Disclosure of Interest None Declared
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