title: The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy.
abstract: BACKGROUND
  There are no guidelines for the recommended interval to the next examination after colonoscopy with suboptimal bowel preparation.
  
  
  OBJECTIVE
  To identify factors associated with early repeat colonoscopy after initial examinations with suboptimal preparations and to measure adenoma miss rates in this context.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Hospital-based endoscopy unit.
  
  
  METHODS
  Bowel preparation quality was recorded in 12,787 patients.
  
  
  RESULTS
  Of 12,787 colonoscopies, preparation quality was suboptimal (poor or fair) in 3047 patients (24%). Among these 3047 patients, repeat examination was performed in <3 years in 505 (17%). Factors associated with early repeat colonoscopy included lack of cecal intubation (odds ratio [OR] 3.62, 95% confidence interval [CI], 2.50-5.24) and finding a polyp (OR 1.55, 95% CI, 1.17-2.07). Among 216 repeat colonoscopies with optimal preparation, 198 adenomas were identified, of which 83 were seen only on the second examination, an adenoma miss rate of 42% (95% CI, 35-49). The advanced adenoma miss rate was 27% (95% CI, 17-41). For colonoscopies repeated in <1 year, the adenoma and advanced adenoma miss rates were 35% and 36%, respectively.
  
  
  CONCLUSIONS
  Single-center, retrospective study.
  
  
  CONCLUSIONS
  Although a minority of patients undergo early repeat examination after colonoscopies done with suboptimal bowel preparation, the miss rates for colonoscopies done with suboptimal bowel preparation were high, suggesting that suboptimal bowel preparation substantially decreases colonoscopy effectiveness and may mandate an early follow-up examination.
authors.affiliation: Department of Medicine, Division of Digestive and Liver Diseases, College of Physicians and Surgeons, Columbia University, New York, New York, USA. BL114@columbia.edu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
authors.forename: Fay
authors.initials: F
authors.lastname: Kastrinos
authors.forename: Michael
authors.initials: M
authors.lastname: Glick
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Rosenbaum
authors.forename: Timothy
authors.initials: T
authors.lastname: Wang
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D002400:Cathartics / Q000008:administration & dosage; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D007507:Therapeutic Irrigation / Q000592:standards; D013997:Time Factors
chemical_list: D002400:Cathartics