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      Predictive factors for missed adenoma on repeat colonoscopy in patients with suboptimal bowel preparation on initial colonoscopy: A KASID multicenter study

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          Abstract

          Suboptimal bowel preparation can result in missed colorectal adenoma that can evolve into interval colorectal cancer. This study aims to identify the predictive factors associated with missed adenoma on repeat colonoscopy in patients with suboptimal bowel preparation at initial colonoscopy. A total of 441 patients with suboptimal bowel preparation on initial colonoscopy and who had repeat colonoscopy within two years were included from 2007 to 2014 in six tertiary hospitals. Suboptimal bowel preparation was defined as ‘poor’ according to the Aronchick scale or a score ≤ 1 in at least one segment or total score < 6 according to the Boston bowel preparation scale. Of 441 patients, mean age at initial colonoscopy was 59.1 years, and 69.2% patients were male. The mean interval from initial to repeat colonoscopy was 14.1 months. The per-patient adenoma miss rate (AMR) was 42.4% for any adenoma and 5.4% for advanced adenoma. When the association between baseline clinical characteristics and missed lesions on repeat colonoscopy was analyzed, dyslipidemia (odds ratio [OR], 5.19; 95% confidence interval [CI], 1.14–23.66; P = 0.034), and high-risk adenoma (OR, 4.45; 95% CI, 1.12–17.68; P = 0.034) on initial colonoscopy were independent risk factors for missed advanced adenoma. In patients with suboptimal bowel preparation, dyslipidemia and high-risk adenoma on initial colonoscopy were independently predictive of missed advanced adenoma on repeat colonoscopy.

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          Most cited references 35

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          Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.

          In the National Polyp Study (NPS), colorectal cancer was prevented by colonoscopic removal of adenomatous polyps. We evaluated the long-term effect of colonoscopic polypectomy in a study on mortality from colorectal cancer. We included in this analysis all patients prospectively referred for initial colonoscopy (between 1980 and 1990) at NPS clinical centers who had polyps (adenomas and nonadenomas). The National Death Index was used to identify deaths and to determine the cause of death; follow-up time was as long as 23 years. Mortality from colorectal cancer among patients with adenomas removed was compared with the expected incidence-based mortality from colorectal cancer in the general population, as estimated from the Surveillance Epidemiology and End Results (SEER) Program, and with the observed mortality from colorectal cancer among patients with nonadenomatous polyps (internal control group). Among 2602 patients who had adenomas removed during participation in the study, after a median of 15.8 years, 1246 patients had died from any cause and 12 had died from colorectal cancer. Given an estimated 25.4 expected deaths from colorectal cancer in the general population, the standardized incidence-based mortality ratio was 0.47 (95% confidence interval [CI], 0.26 to 0.80) with colonoscopic polypectomy, suggesting a 53% reduction in mortality. Mortality from colorectal cancer was similar among patients with adenomas and those with nonadenomatous polyps during the first 10 years after polypectomy (relative risk, 1.2; 95% CI, 0.1 to 10.6). These findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer. (Funded by the National Cancer Institute and others.).
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            Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer.

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              The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research.

              Few bowel-preparation rating scales have been validated. Most scales were intended for comparing oral purgatives and fail to account for washing and/or suctioning by the endoscopist. This limits their utility in studies of colonoscopy outcomes, such as polyp-detection rates. To develop a valid and reliable scale for use in colonoscopy outcomes research. Academic medical center. We developed the Boston bowel preparation scale (BBPS), a 10-point scale that assesses bowel preparation after all cleansing maneuvers are completed by the endoscopist. We assessed interobserver and intraobserver reliability by using video footage of colonoscopies viewed on 2 separate occasions by 22 clinicians. We then applied the BBPS prospectively during screening colonoscopies and compared BBPS scores with clinically meaningful outcomes, including polyp-detection rates and procedure times. The intraclass correlation coefficient (a measure of interobserver reliability) for BBPS scores was 0.74. The weighted kappa (a measure of intraobserver reliability) for scores was 0.77 (95% CI, 0.66-0.87). During 633 screening colonoscopies, the mean (SD) BBPS score was 6.0 +/- 1.6. Higher BBPS scores (> or =5 vs <5) were associated with a higher polyp-detection rate (40% vs 24%, P < .02). BBPS scores were inversely correlated with colonoscope insertion (r = -0.16, P < .003) and withdrawal (r = -0.23, P < .001) times. Single-center study. The BBPS is a valid and reliable measure of bowel preparation. It may be well suited to colonoscopy outcomes research because it reflects the colon's cleanliness during the inspection phase of the procedure.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draft
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Data curation
                Role: Data curationRole: Formal analysisRole: InvestigationRole: Methodology
                Role: Data curation
                Role: Data curation
                Role: Data curation
                Role: ConceptualizationRole: MethodologyRole: Supervision
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                26 April 2018
                2018
                : 13
                : 4
                Affiliations
                [1 ] Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
                [2 ] Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Republic of Korea
                [3 ] Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
                [4 ] Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
                [5 ] Department of Internal Medicine, Division of Gastroenterology, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
                [6 ] Department of Internal Medicine, Chonbuk National University College of Medicine, Jeonju, Republic of Korea
                [7 ] Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
                University of Munich, GERMANY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ These authors are co-first authors on this work. JYC and HJY also contributed equally to this work.

                Article
                PONE-D-17-43941
                10.1371/journal.pone.0195709
                5919514
                29698398
                © 2018 Chang et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 1, Tables: 4, Pages: 14
                Product
                Funding
                Funded by: National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT)
                Award ID: 2010-0027945
                Award Recipient :
                Funded by: Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education
                Award ID: 2017R1D1A1B03035311
                Award Recipient :
                This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (2010-0027945) and this research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (grant number; 2017R1D1A1B03035311, Chang Mo Moon).
                Categories
                Research Article
                Medicine and Health Sciences
                Oncology
                Cancers and Neoplasms
                Adenomas
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Digestive System Procedures
                Colonoscopy
                Biology and Life Sciences
                Anatomy
                Digestive System
                Gastrointestinal Tract
                Colon
                Medicine and Health Sciences
                Anatomy
                Digestive System
                Gastrointestinal Tract
                Colon
                Medicine and Health Sciences
                Oncology
                Cancers and Neoplasms
                Colorectal Cancer
                Medicine and Health Sciences
                Metabolic Disorders
                Dyslipidemia
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Endoscopy
                Medicine and Health Sciences
                Vascular Medicine
                Thromboembolism
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Abdominal Surgery
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

                Uncategorized

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