title: The Effect of the Bowel Preparation Status on the Risk of Missing Polyp and Adenoma during Screening Colonoscopy: A Tandem Colonoscopic Study.
abstract: OBJECTIVE
  Although a small amount of fecal material can obscure significant colorectal lesions, it has not been well documented whether bowel preparation status affects the missing risk of colorectal polyps and adenomas during a colonoscopy.
  
  
  METHODS
  We prospectively enrolled patients with one to nine colorectal polyps and at least one adenoma of >5 mm in size at the screening colonoscopy. Tandem colonoscopy with polypectomy was carried out within 3 months.
  
  
  RESULTS
  A total of 277 patients with 942 polyps and 714 adenomas completed index and tandem examinations. At the index colonoscopy, 187 polyps (19.9%) and 127 adenomas (17.8%) were missed. The per-patient miss rate of polyps and adenomas increased significantly as the bowel cleansing rate declined from excellent to poor/inadequate on the Aronchick scale (polyps, p=0.024; adenomas, p=0.040). The patients with poor/inadequate bowel preparation were independently associated with an increased risk of having missed polyps (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.13 to 9.15) or missed adenomas (OR, 3.04; 95% CI, 1.04 to 8.88) compared to the patients with excellent bowel preparation.
  
  
  CONCLUSIONS
  The risk of missing polyps and adenomas during screening colonoscopy is significantly affected by bowel preparation status. It seems appropriate to shorten the colonoscopy follow-up interval for patients with suboptimal bowel preparation.
authors.affiliation: Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea. ; Healthcare Center, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea. ; Medical Immunology Center, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Sung Noh
authors.initials: SN
authors.lastname: Hong
authors.forename: In Kyung
authors.initials: IK
authors.lastname: Sung
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Kim
authors.forename: Won Hyeok
authors.initials: WH
authors.lastname: Choe
authors.forename: Byung Kook
authors.initials: BK
authors.lastname: Kim
authors.forename: Soon Young
authors.initials: SY
authors.lastname: Ko
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Lee
authors.forename: Dong Choon
authors.initials: DC
authors.lastname: Seol
authors.forename: Su Young
authors.initials: SY
authors.lastname: Ahn
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Lee
authors.forename: Hyung Seok
authors.initials: HS
authors.lastname: Park
authors.forename: Chan Sup
authors.initials: CS
authors.lastname: Shim