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Intermediate-, high-quality bowel preparations resulted in similar adenoma detection rates
Adenoma detection rate with intermediate-quality bowel preparation before colonoscopy did not differ significantly from the rate associated with high-quality bowel preparation, suggesting that a standard follow-up surveillance interval is appropriate, according to new research data.
“The adenoma detection rate with fair bowel prep is not significantly less than with excellent/good bowel prep, suggesting that a shortened interval to the next colonoscopy may not be necessary in patients with a fair prep,” Brian T. Clark, MD, Yale University School of Medicine, told Healio.com/Gastroenterology.
In an effort to make assignment of post-colonoscopy surveillance intervals more data-driven, Clark and colleagues performed a systematic review and meta-analysis of studies through October 2013 to determine if different adenoma detection rates (ADR) corresponded to varying levels of bowel preparation quality.
Eleven studies were included in the final analysis, and quality definitions were standardized based on Aronchick definitions (high [excellent/good], intermediate [fair] and low [poor/insufficient]) and also by dichotomized analysis based on Boston Bowel Preparation score (adequate [excellent/good/fair] vs. inadequate [poor/insufficient]).
Pooled analysis of ADR associated with intermediate- vs. high-quality bowel preparation showed an OR of 0.94 (95% CI; 0.8-1.1) with an estimated absolute risk difference of –1% (–3% to 2%). Compared with low-quality preparation, both intermediate- (OR=1.39; 95% CI, 1.08-1.79) and high-quality (OR=1.41; 95% CI, 1.21-1.64) preparation had higher ADR, both with 5% absolute risk increases. ADR (OR=1.3; 95% CI, 1.19-1.42) and advanced ADR (OR=1.3; 95% CI, 1.02-1.67) were significantly higher with adequate vs. inadequate preparation.
This study “demonstrated no significant difference in ADR between high-quality and intermediate-quality bowel preparation, with similar significant increases in ADR for both high-quality and intermediate-quality preparation as compared with low-quality preparation,” the researchers concluded. “Our results confirm the need for early repeat colonoscopy for low-quality bowel preparation, but suggest that patients with intermediate/fair preparation quality may be followed up at standard guideline-recommended surveillance intervals without significantly affecting quality as measured by ADR.”
Disclosure: The researchers report no relevant financial disclosures.