Mohammad Alomari, MD1, Laith Al Momani, MD2, Muhammad Talal Sarmini, MD1, Shrouq Khazaaleh, MD3, Fredy Nehme, MD4, Vaibhav Wadhwa, MD5, Prashanthi N. Thota, MD6, Madhusudhan R. Sanaka, MD, FACG6
1Cleveland Clinic Foundation, Cleveland, OH; 2East Tennessee State University, Johnson City, TN; 3King Abdullah University Hospital, Ar Ramtha, Irbid, Jordan; 4University of Missouri, Kansas City, MO; 5Cleveland Clinic, Weston, FL; 6Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH
Introduction: Adenoma detection rate (ADR) is an established colonoscopy quality metric with higher rates associated with reduced interval colorectal cancer. Adequate colon visualization and hence sufficient bowel preparation are crucial for effective colonoscopy. Due to inconsistency in the adequate bowel preparation definition using the Aronchick scale, we aimed in this study to investigate the impact of bowel preparation on overall and segment-specific ADR and polypectomy rates (PR).
Methods: A retrospective review of all screening colonoscopies in patients ≥50 years of age performed at our institution between 2012 and 2014 was done. Average risk patients who had a complete colonoscopy with excellent, good and fair bowel preparation as per the Aronchick scale were included. Overall, gender-specific and colon segment-specific ADR and PR were calculated and compared using t-tests. All analyses were done using SAS (version 9. 4, The SAS Institute, Cary, NC) and a p-value < 0. 05 was considered statistically significant.
Results: A total of 4151 patients were included in the analysis. Average patient age was 60.0±7.7 years and 53.2% were females. A total of 652(15.7%) had excellent preparation, 2675(64.4%) had good preparation and 824(19.9%) had fair preparation. (Table 1) Overall ADR was significantly lower in patients with fair preparation (21.1±27.0) than in those with good preparation (27.6±12.8 ; P < 0.012). Overall PR, proximal PR, and distal PR were significantly lower in patients with fair bowel preparation (38.0±34.1, 25.0±29.9 and 25.0±29.9, respectively) compared to those with good bowel preparation (45.9±19.8; P =0.048; 28.1±16.4; P =0.042; 29.4±14.3; P =0.044, respectively). (Table 2)
Discussion: The Aronchick Scale is one of the most commonly used validated bowel preparation quality scales in clinical practice. However, to date, there is no uniform definition of the adequate bowel preparation as some use a composite of “excellent”, “good” and “fair” preparation while others define it as a composite of “good” and “excellent” preparation. In our study, patients with fair standards of preparation had significantly lower overall and segment-specific ADR and PR than those with good bowel preparation. Moreover, in patients with fair colonoscopy preparation, endoscopists didn't reach their recommended overall and gender-specific ADR benchmarks. Thus, an earlier surveillance colonoscopy may be considered in those patients.
Citation: Mohammad Alomari, MD; Laith Al Momani, MD; Muhammad Talal Sarmini, MD; Shrouq Khazaaleh, MD; Fredy Nehme, MD; Vaibhav Wadhwa, MD; Prashanthi N. Thota, MD; Madhusudhan R. Sanaka, MD, FACG. P0131 - FAIR COLONOSCOPY BOWEL PREPARATION IS NOT ADEQUATE FOR EFFECTIVE COLONOSCOPY. Program No. P0131. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.