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EFFECT OF DIFFERENT QUALITIES OF BOWEL PREPARATION ON ADENOMA DETECTION RATE, DETECTION OF ADVANCED ADENOMAS AND SERRATED ADENOMAS: 10-YEAR RESULTS FROM A LARGE COLORECTAL CANCER SCREENING COHORT IN AUSTRIA

Entcho Klenske 1, Lisa-Maria Rockenbauer 1, Jasmin Zessner-Spitzenberg 1, Daniela Penz 1, Elisabeth Waldmann 1, Alexandra Demschik 1, Ian Schotzko 1, Arno Asaaturi 1, Michael Trauner 2, Monika Ferlitsch 1

Affiliations

1 Medical University of Vienna, Vienna, Austria

2 Head of Division of Gastroenterology and Hepatology - Department of Medicine III, Wien, Austria

Summary

AI Generated

Analysis of 375,352 colonoscopies from the Austrian screening program shows that adequate bowel preparation achieves the recommended ADR ≥25% standard, while poor preparation yields unexpectedly low cecal intubation rates but does not appear to reduce advanced adenoma detection.

Among 375,352 colonoscopies categorized by Aronchik Scale, adequate preparations (excellent, good, fair) achieved ADR of 26.9%, 27.2%, and 27.2% respectively, meeting the international standard of ≥25%.
Poor bowel preparation resulted in a cecal intubation rate of only 57.3%, substantially lower than the ≥90% rates seen in both adequate and insufficient preparations, with extensive fecal contamination cited in 93.2% of incomplete cases.
Advanced adenoma detection rates were not inferior in inadequate bowel preparation groups (7.3% in poor, 4% in insufficient) compared to adequate preparations (3.1-3.3%), suggesting advanced adenomas may be detected despite suboptimal preparation.
Mean overall detection rates across all preparations were ADR 23.8%, SSADR 8.5%, and AADR 4.2% in this large real-world screening cohort from 2012-2022.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Adequate bowel preparation is a well-established quality parameter for screening colonoscopies correlating with another important quality parameter of colonoscopy, the adenoma detection rate (ADR). Additional parameters like sessile serrated adenoma detection rate (SSADR) and advanced adenoma detection rate (AADR) have been discussed as additional quality indicators without a clear correlation with bowel preparation quality.

Aims & Methods

In this study we aimed to compare ADR, AADR and SSADR between different bowel preparation qualities in a large real-world colorectal cancer screening cohort.
Colonoscopy data from the Austrian national colorectal cancer screening program collected between 2012 and 2022 were analysed. Bowel preparation was categorized into five different groups (excellent, good, fair, poor and insufficient) according to the Aronchik Scale. ADR, SSADR and AADR were calculated for each group.

Results

A total of 375,352 colonoscopies (48.2 % in men) performed by 404 endoscopists working in hospitals and private practices were included in the final analysis. The cecal intubation rate (CIR) was ≥90% in adequate bowel preparations and also in insufficient bowel preparations. However, CIR in poor bowel preparations was only 57.3%. The most common reasons for incomplete colonoscopy in these patients, as stated by the treating endoscopist, was extensive fecal contamination in 93.2% of cases. Mean overall ADR, SSADR and AADR were 23.8%, 8.5% and 4.2%, respectively. ADR/SSADR/AADR in excellent, good, fair, poor and insufficient bowel preparations were 26.9%/10.1%/3.1%, 27.2/8.5%/3.3%, 27.2/8.5%/3.3%, 15.3/9.2%/7.3% and 22,5/6.4%/4%, respectively. In patients with insufficient bowel preparation exclusively in the right colon, ADR/SSADR and AADR were 25.9%/4.9% and 3.1%.

Conclusion

The recommended international standard of an ADR ≥25% was achieved in patients with adequate (excellent, good and fair) bowel preparations. Interestingly, the CIR in poor bowel preparations was very low (57.3%) even compared with the CIR in insufficient bowel preparations (89.9%). Further, detection of advanced adenomas was not inferior in the inadequate bowel preparation groups, suggesting that these types of adenomas might be also seen without an adequate bowel preparation.

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

Lower GI endoscopic polypectomy (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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