title: Adenoma detection in excellent versus good bowel preparation for colonoscopy.
abstract: OBJECTIVE
  To determine whether Excellent bowel cleansing is superior to Good for the detection of adenomas.
  
  
  BACKGROUND
  High quality colonoscopy requires Adequate bowel preparation. However, it is unknown whether adenoma detection differs between subcategories of Adequate cleansing.
  
  
  METHODS
  We utilized a retrospective, cross-sectional study design to obtain data about patients undergoing colonoscopy at a single university center between August 31, 2011 and September 1, 2012. Primary outcome was adenoma detection rate (ADR), the percentage of patients with ≥1 adenoma. Secondary outcomes included adenomas per colonoscopy, adenoma distribution (proximal vs. distal), and detection of advanced adenomas, sessile serrated polyps (SSP), and cancer.
  
  
  RESULTS
  The electronic medical record of 5113 consecutive colonoscopies with Good or Excellent preparation was queried for preparation quality, colonoscopy indication, demographics, medical history, and history of adenoma and colon cancer. Exclusion criteria were age below 18 years, inflammatory bowel disease, or familial polyposis. Adenoma detection was not superior with Excellent cleansing as compared with Good for ADR [respectively, 26% vs. 29%, odds ratio 0.97 (0.85, 1.11), P=0.618] or adenomas per colonoscopy [respectively, 0.437 vs. 0.499, incidence rate ratio (IRR) 0.98 (0.90, 1.07), P=0.705]. Excellent cleansing demonstrated superior detection of SSPs [IRR 1.66 (1.14, 2.40), P=0.008] and advanced adenomas [IRR 1.37 (1.09, 1.72), P=0.007] but not colon cancer [odds ratio 0.286 (0.083, 0.985), P=0.0474].
  
  
  CONCLUSIONS
  ADR is not significantly different between the Adequate subcategories of Excellent and Good. However, Excellent cleansing is associated with superior detection of advanced adenomas and SSPs. If confirmed, achieving an Excellent preparation may improve colonoscopy performance in the proximal colon where SSPs primarily occur.
authors.affiliation: Departments of *Medicine ‡Gastroenterology, Thomas Jefferson University Hospital †Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Tholey
authors.forename: Corbett E
authors.initials: CE
authors.lastname: Shelton
authors.forename: Gloria
authors.initials: G
authors.lastname: Francis
authors.forename: Archana
authors.initials: A
authors.lastname: Anantharaman
authors.forename: Robert A
authors.initials: RA
authors.lastname: Frankel
authors.forename: Paurush
authors.initials: P
authors.lastname: Shah
authors.forename: Amy
authors.initials: A
authors.lastname: Coan
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hegarty
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Leiby
authors.forename: David M
authors.initials: DM
authors.lastname: Kastenberg
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D002400:Cathartics / Q000592:standards*; D003111:Colonic Polyps / Q000175:diagnosis; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies
chemical_list: D002400:Cathartics