Abstract
Background/Aims Bowel preparation quality is critical to adequate visualization of adenomas during colonoscopy. We determined the total per person adenoma count (PPAC) in a population undergoing screening colonoscopy during a six month period to assess the utility of this measure as an indicator of bowel preparation quality.
Methods Records of outpatients 50–74 years who had undergone screening colonoscopy between September 1, 2012, and February 28, 2013 were extracted. Excluded were diagnostic and surveillance colonoscopies, pre-surgical assessment for organ transplant, and persons with inflammatory bowel disease, and personal or family history of hereditary non-polyposis colorectal cancer, colorectal cancer or polyps. Colonoscopy and pathology reports were manually reviewed to abstract age, gender, examination date, time of procedure, bowel preparation quality, procedural difficulty and tolerability, and number, type, and size of adenomas. Comparisons between those in whom adenomas were and were not detected were performed and associations between study covariates and adenomas detected were examined using multivariable regression. PPAC and adenoma detection rate (ADR) by level of preparation quality were calculated.
Results Of 1584 colonoscopies identified, 815 (51.4%) were screening colonoscopies and, of these, =1 adenomas were detected in 203 (24.9%). Most patients were <60 years of age (52.5%) and female (57.4%). Bowel preparation quality was “excellent” or “good” for 81.7% of procedures. Adenomas were more often detected among those >60 years (aOR 1.69, 95%CI 1.21–2.36) and males (aOR 1.61, 95%CI 1.15–2.26). The mean PPAC overall was 0.34 (SD 0.68) and was associated with age >60 years (P<0.001) and male gender (P<0.001). When analysis was restricted to only those with =1 adenomas, a negative linear trend of PPAC was observed with PPAC highest among excellent quality preparations (1.48 [SD 1.05]), and lowest for poor preparation quality (1.00 [SD 0.00], P = 0.55). The overall ADR was 25.0% and by bowel preparation quality was 21.7% for excellent preparation, 26.6% for good, 25.5% for fair, and 13.1% for poor.
Conclusions Our findings suggest that PPAC is sensitive to changes in bowel preparation quality but is particularly sensitive when restricted to only those in whom adenomas were seen. Further exploration of PPAC as a bowel preparation quality indicator is warranted.
