The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy.
The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy.
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DOI：
10.1016/j.gie.2011.01.051
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发表时间：
2011-06
影响因子：
7.7
通讯作者：
Neugut AI
中科院分区：
文献类型：
--
作者：
Lebwohl B;Kastrinos F;Glick M;Rosenbaum AJ;Wang T;Neugut AI
对于结肠镜检查后肠道准备不佳的下一次检查的推荐间隔时间，目前尚无指南。目的：确定早期重复结肠镜检查的相关因素，并在此背景下测量腺瘤漏检率。我们分析了3年来在一个单一的医院内窥镜检查单元进行的所有结肠镜检查。我们将非最佳准备后的早期重复结肠镜检查定义为在指标检查3年后进行的检查。腺瘤漏检率的计算方法是用第二次结肠镜检查发现的病变数除以两次检查的总数。在12,787例结肠镜检查中，3047例(24%)患者的制备质量不佳(差或可)。在这3047例患者中，505例(17%)在3年内进行了重复检查。与早期复发相关的因素包括盲肠插管不足(OR 3.62，95%CI 2.50~5.24)和发现息肉(OR 1.55，95%CI 1.17~2.07)。在216次重复结肠镜检查中，发现198个腺瘤，其中83个在第二次检查时才能看到，腺瘤漏检率为42%(95%可信区间35~49)。晚期腺瘤漏诊率为27%(95%可信区间17~41)。1年内重复结肠镜检查，腺瘤漏诊率为35%，晚期腺瘤漏诊率为36%。单中心、回顾性研究。虽然少数患者在准备不佳的结肠镜检查后进行早期重复检查，但准备不佳的结肠镜检查的漏检率很高，这表明不佳的肠道准备大大降低了结肠镜检查的有效性，并可能要求及早进行后续检查。
There are no guidelines for the recommended interval to the next examination after colonoscopy with suboptimal bowel preparation. To identify factors associated with early repeat colonoscopy after initial examinations with suboptimal preparations, and to measure adenoma miss rates in this context. We analyzed all colonoscopies over 3 years at a single, hospital-based endoscopy unit. We defined early repeat colonoscopies after a suboptimal preparation as those occurring <3 years after the index examination. Adenoma miss rates were calculated by dividing the number of lesions found on the second colonoscopy by the total on both examinations. Of 12,787 colonoscopies, preparation quality was suboptimal (poor or fair) in 3,047 (24%) patients. Among these 3,047 patients, repeat examination was performed in <3 years in 505 (17%). Factors associated with early repeat included lack of cecal intubation (OR 3.62, 95%CI 2.50–5.24) and finding a polyp (OR 1.55, 95%CI 1.17–2.07). Among 216 repeat colonoscopies with an optimal preparation, 198 adenomas were identified, of which 83 were only seen on the second examination, an adenoma miss rate of 42% (95%CI 35–49). The advanced adenoma miss rate was 27% (95%CI 17–41). For colonoscopies repeated in <1 year, the adenoma and advanced adenoma miss rates were 35% and 36% respectively. Single-center, retrospective study. While a minority of patients undergo early repeat examination after a suboptimally prepared colonoscopy, the miss rates for suboptimally prepared colonoscopies were high, suggesting that suboptimal bowel preparation substantially decreases colonoscopy effectiveness, and may mandate an early follow-up examination.