Improved bowel preparation increases polyp detection and unmasks significant polyp miss rate.
OBJECTIVE
To retrospectively compare previous-day vs split-dose preparation in terms of bowel cleanliness and polyp detection in patients referred for polypectomy.


METHODS
Fifty patients underwent two colonoscopies: one diagnostic in a private clinic and a second for polypectomy in a University Hospital. The latter procedures were performed within 12 wk of the index ones. Examinations were accomplished by two experienced endoscopists, different in each facility. Twenty-seven patients underwent screening/surveillance colonoscopy, while the rest were symptomatic. Previous day bowel preparation was utilized initially and split-dose for polypectomy. Colon cleansing was evaluated using the Aronchick scale. We measured the number of detected polyps, and the polyp miss rates per-polyp.


RESULTS
Excellent/good preparation was reported in 38 cases with previous-day preparation (76%) vs 46 with split-dose (92%), respectively (P = 0.03). One hundred and twenty-six polyps were detected initially and 169 subsequently (P < 0.0001); 88 vs 126 polyps were diminutive (P < 0.0001), 25 vs 29 small (P = 0.048) and 13 vs 14 equal or larger than 10 mm. The miss rates for total, diminutive, small and large polyps were 25.4%, 30.1%, 13.7% and 6.6%, respectively. Multivariate analysis revealed that split-dose preparation was significantly associated (OR, P) with increased number of polyps detected overall (0.869, P < 0.001), in the right (0.418, P = 0.008) and in the left colon (0.452, P = 0.02).


CONCLUSIONS
Split-dose preparation improved colon cleansing, enhanced polyp detection and unmasked significant polyp miss rates.
Ioannis S Papanikolaou, Athanasios D Sioulas, Iosif Beintaris, Lazaros-Dimitrios Lazaridis, Dimitrios Polymeros, Chrysoula Malli, George D Dimitriadis, Konstantinos Triantafyllou, Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece.
Ioannis S
IS
Papanikolaou
Ioannis S Papanikolaou, Athanasios D Sioulas, Iosif Beintaris, Lazaros-Dimitrios Lazaridis, Dimitrios Polymeros, Chrysoula Malli, George D Dimitriadis, Konstantinos Triantafyllou, Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece.
Athanasios D
AD
Sioulas
Ioannis S Papanikolaou, Athanasios D Sioulas, Iosif Beintaris, Lazaros-Dimitrios Lazaridis, Dimitrios Polymeros, Chrysoula Malli, George D Dimitriadis, Konstantinos Triantafyllou, Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece.
Nektarios
N
Magdalinos
Ioannis S Papanikolaou, Athanasios D Sioulas, Iosif Beintaris, Lazaros-Dimitrios Lazaridis, Dimitrios Polymeros, Chrysoula Malli, George D Dimitriadis, Konstantinos Triantafyllou, Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece.
Iosif
I
Beintaris
Ioannis S Papanikolaou, Athanasios D Sioulas, Iosif Beintaris, Lazaros-Dimitrios Lazaridis, Dimitrios Polymeros, Chrysoula Malli, George D Dimitriadis, Konstantinos Triantafyllou, Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece.
Lazaros-Dimitrios
LD
Lazaridis
Ioannis S Papanikolaou, Athanasios D Sioulas, Iosif Beintaris, Lazaros-Dimitrios Lazaridis, Dimitrios Polymeros, Chrysoula Malli, George D Dimitriadis, Konstantinos Triantafyllou, Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece.
Dimitrios
D
Polymeros
Ioannis S Papanikolaou, Athanasios D Sioulas, Iosif Beintaris, Lazaros-Dimitrios Lazaridis, Dimitrios Polymeros, Chrysoula Malli, George D Dimitriadis, Konstantinos Triantafyllou, Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece.
Chrysoula
C
Malli
Ioannis S Papanikolaou, Athanasios D Sioulas, Iosif Beintaris, Lazaros-Dimitrios Lazaridis, Dimitrios Polymeros, Chrysoula Malli, George D Dimitriadis, Konstantinos Triantafyllou, Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece.
George D
GD
Dimitriadis
Ioannis S Papanikolaou, Athanasios D Sioulas, Iosif Beintaris, Lazaros-Dimitrios Lazaridis, Dimitrios Polymeros, Chrysoula Malli, George D Dimitriadis, Konstantinos Triantafyllou, Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece.
Konstantinos
K
Triantafyllou
Bowel preparation; Colonoscopy; Colorectal cancer; Polyp detection; Polyp miss rate