You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Different Bowel Preparation Schedule Leads to Different Diagnostic Yield of Proximal and Nonpolypoid Colorectal Neoplasm at Screening Colonoscopy in Average-Risk Population

Chiu, Han-Mo M.D., Ph.D.1,4; Lin, Jaw-Town M.D., Ph.D.1,6; Lee, Yi-Chia M.D., Ph.D.1,4; Liang, Jin-Tung M.D., Ph.D.2; Shun, Chia-Tung M.D., Ph.D.3; Wang, Hsiu-Po M.D.1; Wu, Ming-Shiang M.D., Ph.D.1,4,5

Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e318231d667
Original Contribution
Abstract

BACKGROUND: Accumulating evidence indicates that the timing of bowel preparation is crucial, but its impact on the diagnostic yield of proximal or nonpolypoid colorectal neoplasm remains unclear.

OBJECTIVE: This study aimed to investigate the impact of the timing of bowel preparation on the adenoma detection rate for nonpolypoid colorectal neoplasm at colonoscopy.

DESIGN: This study is a retrospective analysis of a screening colonoscopy cohort database.

SETTING: The investigation was conducted at a screening colonoscopy unit in an university hospital.

PATIENTS: A consecutive series of 3079 subjects who received primary screening colonoscopy with different timing of bowel preparation was analyzed.

INTERVENTION: Different timing of bowel preparation (same day vs prior day) was studied.

MAIN OUTCOME MEASURES: The main outcomes measured were patient demographics, timing of bowel preparation, colon-cleansing levels, diagnostic yields of colonoscopy, including adenoma, advanced adenoma, and nonpolypoid colorectal neoplasm.

RESULTS: There were a total of 1552 subjects in the morning group and 1527 in the evening group. More subjects had proximal adenoma (175, 11.3% vs 138, 9.0%, P = .04), advanced adenoma (68, 4.4% vs 46, 13.0%, P = .044), nonpolypoid colorectal neoplasm (98, 6.3% vs 67, 4.4%, P = .018), proximal nonpolypoid colorectal neoplasm (71, 4.6% vs 40, 2.6%, P = .004), and advanced nonpolypoid colorectal neoplasm (25, 1.6% vs 12, 0.8%, P = .036) detected by same-day preparation. On multivariate regression analysis, the adenoma detection rate was significantly higher in the same-day group regarding overall and proximal adenoma (OR 1.23, 95% CI: 1.00–1.50; OR 1.35, 95% CI: 1.05–1.74), advanced adenoma (OR 1.53, 95% CI: 1.04–2.28), overall, proximal, and advanced nonpolypoid colorectal neoplasm (OR 1.48, 95% CI: 1.06–2.08; OR 1.82, 95% CI: 1.20–2.75; OR 1.96, 95% CI: 1.12–3.37). The adenoma detection rate was also significantly different among endoscopists.

LIMITATION: This was a single-center, nonrandomized trial.

CONCLUSIONS: Improving bowel preparation quality by same-day preparation may lead to enhanced detection of overall, proximal, and advanced nonpolypoid colorectal neoplasm.

Author Information

1 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

2 Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan

3 Department of Pathology and Forensic Medicine, National Taiwan University Hospital, Taipei, Taiwan

4 Health Management Center, National Taiwan University Hospital, Taipei, Taiwan

5 Department of Primary Care Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

6 Department of Internal Medicine, E-DA Hospital and I-Shou University, Kaohsiung County, Taiwan

Funding/Support: This work was supported in part by a research grant from the Department of Health of Taiwan (Center of Excellence for Cancer Research, DOH99-TD-C-111-001).

Financial Disclosure: None reported.

Presented at Digestive Disease Week 2010, New Orleans, LA, May 1 to 5, 2010.

This study was conducted with the approval of the institutional review board of National Taiwan University Hospital: 201004029R.

Correspondence: Ming-Shiang Wu, M.D., Ph.D., Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, Taiwan. E-mail: mingshiang@ntu.edu.tw

© The ASCRS 2011