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Poor Bowel Preparation Tied to Missed Adenoma Diagnosis

Colonoscopy with suboptimal preparation may require early repeat procedure to ID adenomas

FRIDAY, June 24 (HealthDay News) -- Patients who undergo colonoscopies with suboptimal preparation of the bowel may have missed adenoma diagnoses, which are detected at repeat colonoscopy, according to a study published in the June issue of Gastrointestinal Endoscopy.

Benjamin Lebwohl, M.D., from Columbia University in New York City, and colleagues investigated the factors associated with early repetition of colonoscopy after suboptimal preparations for the initial examination in 12,787 patients who underwent colonoscopy. They evaluated the number of missed adenoma diagnoses in this context.

The investigators identified 3,047 cases (24 percent) with suboptimal bowel preparation (poor or fair), including 505 cases (17 percent) that underwent repeat examination within three years of initial examination. Lack of cecal intubation and finding a polyp were significantly correlated with early repeat colonoscopy (odds ratio, 3.62 and 1.55, respectively). In 216 repeat colonoscopies with optimal preparation, 198 adenomas were identified, of which 83 were only identified on the second examination, giving an adenoma miss rate of 42 percent and an advanced adenoma miss rate of 27 percent. The miss rates for colonoscopies repeated within a year were 35 percent for adenoma and 36 percent for advanced adenoma.

"Our findings of a miss rate of 42 percent for all adenomas and 27 percent for advanced adenomas suggest that suboptimal bowel preparation has a substantial deleterious impact on the effectiveness of colonoscopy, and follow-up examination within one year should be considered," the authors write.

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