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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 references23

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          Quality indicators for colonoscopy.

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            Comprehensive validation of the Boston Bowel Preparation Scale.

            The Boston Bowel Preparation Scale (BBPS) is a novel bowel cleanliness rating scale that has undergone partial validation previously. To fully validate the BBPS and assess the ease of its dissemination. Observational study. Various endoscopy units worldwide. Endoscopists. Video recordings of colonoscopies with varying degrees of cleanliness were viewed twice by gastroenterologists at 1 medical center. For each video, participants assigned segment and total BBPS scores. Endoscopists worldwide were also surveyed about their experience with the BBPS after viewing an instructional video. Intraclass correlation coefficients and weighted κ values assessed inter- and intrarater reliability, respectively. The BBPS was used among 983 patients undergoing screening colonoscopy. The BBPS demonstrated near-perfect interrater reliability (intraclass correlation coefficient = 0.91) and substantial intrarater reliability (weighted κ = 0.78; 95% CI, 0.73-0.84). Among 983 colonoscopies, right and left colon segment scores of 2 or 3 had a multivariate odds ratio of 1.60 (95% CI, 1.01-2.55) and 2.58 (95% CI, 1.34-4.98), respectively, for polyp detection compared with segment scores of 0 or 1. Endoscopists from a variety of settings worldwide found the BBPS easy to implement and applicable to their patient population. Single-center reliability testing. The BBPS is a valid and reliable instrument for assessing bowel cleanliness during colonoscopy. Segment scores may represent a standardized way to determine bowel preparation adequacy. The BBPS can be easily disseminated through the use of a brief instructional video. Copyright © 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
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              The Miss Rate for Colorectal Adenoma Determined by Quality-Adjusted, Back-to-Back Colonoscopies

              Background/Aims Colonoscopy is considered to be the gold standard for detecting adenomatous polyps. Polyps are missed during colonoscopic examination at a rate that varies from 6% to 27%. The adenoma miss rate affects colonoscopic surveillance intervals and procedural quality. We aimed to assess the adenoma miss rate and the variables affecting the rate using same-day, quality-adjusted, back-to-back colonoscopies. Methods This prospective study was performed at a single institution and included 149 patients. Two consecutive same-day colonoscopies were performed by two experienced endoscopists. The adenoma miss rates and variables affecting the missed adenomas, including polyp characteristics and procedure times, were evaluated. Results The miss rates of polyps, adenomas, and advanced adenomas were 16.8%, 17%, and 5.4%, respectively. The smaller polyps and increased number of polyps detected during the first colonoscopy were more likely to be missed. A longer insertion time during the colonoscopy was correlated with an increased adenoma detection rate. Conclusions There was a significant miss rate in the detection of colonic adenomas even in quality-adjusted, back-to-back colonoscopies. The adenoma miss rate can be reduced with a sufficient observation time during colonoscopic insertion. The development of specific technological methods to reduce the adenoma miss rate is necessary.
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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
                : e0195709
                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.

                Author information
                http://orcid.org/0000-0003-2550-913X
                Article
                PONE-D-17-43941
                10.1371/journal.pone.0195709
                5919514
                29698398
                d32d2c54-2d37-4243-a6a8-8172fb111ebb
                © 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.

                History
                : 16 December 2017
                : 28 March 2018
                Page count
                Figures: 1, Tables: 4, Pages: 14
                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.

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