title: Impact of Bowel Preparation Quality on Adenoma Identification During Colonoscopy and Optimal Timing of Surveillance.
abstract: BACKGROUND
  All present guidelines regarding surveillance intervals after index colonoscopy are based on optimal bowel preparation. However, the appropriate timing of repeat colonoscopy after suboptimal bowel preparation is not clear.
  
  
  OBJECTIVE
  To determine the appropriate timing of repeat colonoscopy following index colonoscopy with suboptimal bowel preparation.
  
  
  METHODS
  The medical records of patients who underwent colonoscopy over 5 years were retrospectively analyzed. Index colonoscopy was defined as the first colonoscopy in patients who underwent the procedure at least twice during the study period. Bowel preparation quality was classified as optimal, fair, or poor.
  
  
  RESULTS
  The overall adenoma detection rate was 39.1% (95% confidence interval [CI], 38.0-40.1%), but the detection rate depended significantly on bowel preparation quality (p < 0.001). The adenoma miss rate (AMR) was significant after poor (69.6%) than after optimal (27.3%) and fair (48.1%) preparation (p < 0.001). At surveillance intervals ≤2 years, the odds ratio (OR) for AMR was significantly higher for poor (OR 6.25; 95% CI, 3.76-11.83) and fair (OR 3.67; 95% CI, 2.19-6.16) preparation relative to optimal preparation; however, no difference was observed at surveillance intervals >2 years.
  
  
  CONCLUSIONS
  Bowel preparation quality significantly affects AMR. Colonoscopy should be repeated within 2 years in patients with suboptimal bowel preparation at index colonoscopy.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Ju Seok
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea. porrtos@hanmail.net.
authors.forename: Sun Hyung
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Hee Seok
authors.initials: HS
authors.lastname: Moon
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Eaum Seok
authors.initials: ES
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Seok Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Jae Kyu
authors.initials: JK
authors.lastname: Sung
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Byung Seok
authors.initials: BS
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Hyun Yong
authors.initials: HY
authors.lastname: Jeong
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Woo Suk
authors.initials: WS
authors.lastname: Chung
mesh_terms: D000236:Adenoma / Q000453:epidemiology* / Q000473:pathology; D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000473:pathology; D003111:Colonic Polyps / Q000453:epidemiology* / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D016001:Confidence Intervals; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011786:Quality Control; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D007507:Therapeutic Irrigation / Q000379:methods*
keywords: Bowel preparation; Colonic polyps; Colonoscopy; Surveillance