Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2015; 3(10): 880-886
Published online Oct 16, 2015. doi: 10.12998/wjcc.v3.i10.880
Improved bowel preparation increases polyp detection and unmasks significant polyp miss rate
Ioannis S Papanikolaou, Athanasios D Sioulas, Nektarios Magdalinos, Iosif Beintaris, Lazaros-Dimitrios Lazaridis, Dimitrios Polymeros, Chrysoula Malli, George D Dimitriadis, Konstantinos Triantafyllou
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 Magdalinos, Salamina General Private Cinic, 18900 Salamina, Greece
Author contributions: Papanikolaou IS, Polymeros D, Dimitriadis GD and Triantafyllou K conceived the idea and designed the study; Papanikolaou IS and Magdalinos N performed the research; Beintaris I, Lazaridis LD and Malli C collected the data; Triantafyllou K analyzed the data; Papanikolaou IS, Sioulas AD and Triantafyllou K drafted the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: IRBS was considered to be non-obligatory given that patients received the standard-of-care treatment in both endoscopic departments. Additionally, our retrospective research project involves use of existing information collected from human participants, but there are not any identifiers linking individuals to the data.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: None to declare.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Athanasios D Sioulas, MD, PhD, Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Rimini 1, 12462 Haidari, Greece. athsioulas@yahoo.gr
Telephone: +30-697-4840723 Fax: +30-210-5832090
Received: January 31, 2015
Peer-review started: February 2, 2015
First decision: July 6, 2015
Revised: July 26, 2015
Accepted: September 16, 2015
Article in press: September 18, 2015
Published online: October 16, 2015
Abstract

AIM: 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).

CONCLUSION: Split-dose preparation improved colon cleansing, enhanced polyp detection and unmasked significant polyp miss rates.

Keywords: Colonoscopy, Bowel preparation, Polyp miss rate, Polyp detection, Colorectal cancer

Core tip: Colonoscopy and polypectomy are currently considered as the gold standard to prevent colorectal cancer. However, a significant proportion of precancerous lesions are missed during the procedure, limiting its efficacy and giving rise to interval cancers. Adequate bowel cleanliness represents a major factor with regards to colonoscopy quality. This study demonstrates that split-dose bowel preparation results to significantly better mucosal cleansing compared to previous-day preparation. Moreover, we showed that preparation with the split-dose regimen significantly enhanced polyp detection, especially of the diminutive ones. Finally, better inspection of the colonic epithelium unmasked a notable polyp miss rate.