PTH-058 Attempting total colonoscopy in inadequately prepared bowel: the devil is in the detail!. (June 2019) - Argyriou, Konstantinos
Abstract : Introduction: Bowel preparation (BP) is a fundament for high-quality colonoscopy. Current guidelines suggest repeating colonoscopy within 1 year in case of inadequate bowel preparation (IBP). Up to 83% of individuals does not repeat the examination, with cecal intubation (CI) . Concurrently, in UK, endoscopists attempt full colonoscopy even if the BP is inadequate, so as to avoid being penalized with low CI rate. The implications of this practice remain unknown. Methods: In a cohort of outpatients with IBP, we aimed to investigate the effect of CI at index colonoscopy on early repeat the examination, and to describe the implications on detecting colorectal neoplasia. Over a 2-year period (2013–2014), all outpatients who underwent colonoscopy in our center IBP, were identified. Endoscopic records were reviewed as per BP quality, limit of examination, timing between colonoscopies as well as the identification of polyps (size, type, number) and cancer for a minimum 3-year period. BP quality was dichotomized as adequate or inadequate as per the 2012 U.S. Multi-Society Task Force definition for IBP. Multivariate analysis performed to identify factors associated with early repeat colonoscopy. Results: Of 12.948 colonoscopies, IBP was identified in 944. Over the follow-up period, colonoscopy was repeated in 396 (41.9%) individuals. The mean time (standard deviation) interval between index and repeat colonoscopy was 412 (517) days. At index colonoscopy, CI was achieved in 654 cases (69.6%). Adenomas (A) were identified in 128 cases advanced neoplasia [62 advanced adenomas (AA)and 41 cancers (c)]. Being on a screening/surveillance program [sig: .00, Exp(B): .34, 95% C.I.: .24-.48)] and reaching the caecum at index procedure were negatively associated with early repeating colonoscopy. [sig: .00, Exp(B): .46, 95% C.I.: .34-.62)] Among outpatients CI at index examination, 253 had a repeat colonoscopy. 125 A, 17 AA and 2 c were only seen on the second examination, corresponding to a miss rate of 38.8%, 20.5% and 8.33% respectively. Conclusion: 2 out of 5 outpatients with IBP colonoscopy within 3 years. Miss rates for neoplasia is high for colonoscopies with IBP. CI is an independent predictor for not repeating coloscopy in the subsequent 3-year period. Considering that endoscopists are urged to reach the caecum in each colonoscopy, guidelines need to define how to deal with the cases of IBP, so as to ensure high-quality examinations and an early repeat colonoscopy.