Impact of Split Dose Bowel Preparation on Sessile Serrated Adenoma/Polyp Detection Rate

Abstract Background Prior studies before the widespread use of split-dose bowel preparation have shown a high rate of inadequate bowel preparation in hospitalized patients. Whether this is still true in the era of split-dose bowel preparation is unknown. Aims To determine the impact of inpatient status on bowel preparation quality in the contemporary era of split-dose bowel preparation. Methods The Southwest Ontario Colonoscopy cohort consists of all inpatient and outpatient colonoscopies performed between April 2017 and Oct 2018 at 21 hospitals serving a large geographic health region. Procedures done in patients < 18 years of age or by an endoscopist performing <50 colonoscopies/year were excluded. Data were collected through a mandatory quality assurance form that was completed by the endoscopist after each procedure. Pathology reports were manually reviewed. The primary outcome was adequate bowel preparation, defined on an ordinal scale as “good” or “fair” rather than “poor”. Secondary outcomes included adenoma detection rate (ADR), sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), and cecal intubation rate (CIR). Results A total of 47,292 colonoscopies were performed by 75 physicians (36.2% by gastroenterologists, 60% by general surgeons, 4% others), of which 1,690 were inpatients (3.6%). Inpatients were older (mean 66.8 years vs 60.2 years, p<0.0001), more co-morbid (≥ASA grade 3, 53.6% vs 23.7%, p<0.0001), performed for symptomatic indications (95.7% vs 48.6%, p< 0.0001), have trainee involvement (47% vs 11.6% p<0.001), and less likely to receive split-dose bowel preparation (71.7% vs 91.6% p<0.001). On crude analysis, inpatients were less likely to have adequate bowel preparation (86.2% vs 97.6% p<0.001). On multi-variable analysis, inpatients had lower odds of achieving adequate bowel preparation (OR=0.41, 95% CI 0.33 - 0.50, p<0.001), lower ADR (OR=0.47, 95% CI 0.40 - 0.55, p<0.001), lower PDR (OR=0.54, 95% CI 0.47 - 0.61 p<0.001) and lower CIR (OR = 0.43, 95% CI 0.35 - 0.54, p<0.001). Conclusions In the era of split-dose bowel preparation, inpatient status is still an important predictor of inadequate bowel preparation with resultant lower quality outcome metrics. Funding Agencies None

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Enhanced Patient Education for Colonic Polyp and Adenoma Detection: Meta-Analysis of Randomized Controlled Trials (Preprint)

10.2196/preprints.17372 ◽

2019 ◽

Author(s):

Xu Tian ◽

Ling-Li Xu ◽

Xiao-Ling Liu ◽

Wei-Qing Chen

Keyword(s):

Detection Rate ◽

Meta Analysis ◽

Adenoma Detection Rate ◽

Advanced Adenoma ◽

Polyp Detection ◽

Sessile Serrated Adenoma ◽

Serrated Adenoma ◽

Polyp Detection Rate ◽

Adenoma Detection ◽

Number Of Patients

BACKGROUND To improve patients’ comprehension of bowel preparation instructions before colonoscopy, enhanced patient education (EPE) such as cartoon pictures or other visual aids, phone calls, mobile apps, multimedia education and social media apps have been proposed. However, it is uncertain whether EPE can increase the detection rate of colonic polyps and adenomas. OBJECTIVE This meta-analysis aimed to evaluate the efficacy of EPE in detecting colonic polyps and adenomas. METHODS We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from their inception to June 2019 for the identification of trials comparing the EPE with standard patient education for outpatients undergoing colonoscopy. We used a random effects model to calculate summary estimates of the polyp detection rate (defined as the number of patients with at least one polyp divided by the total number of patients undergoing selective colonoscopy), adenoma detection rate (defined as the number of patients with at least one adenoma divided by the total number of patients undergoing selective colonoscopy), advanced adenoma detection rate (defined as the number of patients with at least one advanced adenoma divided by the total number of patients undergoing selective colonoscopy), sessile serrated adenoma detection rate (defined as the number of patients with at least one sessile serrated adenoma divided by the total number of patients undergoing selective colonoscopy), cancer detection rate (defined as the number of patients with at least one cancer divided by the total number of patients undergoing selective colonoscopy), or adenoma detection rate - plus (defined as the number of additional adenomas found after the first adenoma per colonoscopy). Moreover, we conducted trial sequential analysis (TSA) to determine the robustness of summary estimates of all primary outcomes. RESULTS We included 10 randomized controlled trials enrolling 4560 participants for analysis. The meta-analysis suggested that EPE was associated with an increased polyp detection rate (9 trials; 3781 participants; risk ratio [RR] 1.19, 95% CI 1.05-1.35; P<.05; I2=42%) and adenoma detection rate (5 trials; 2133 participants; RR 1.37, 95% CI 1.15-1.64; P<.001; I2=0%), which were established by TSA. Pooled result from the inverse-variance model illustrated an increase in the sessile serrated adenoma detection rate (3 trials; 1248 participants; odds ratio 1.76, 95% CI 1.22-2.53; P<.05; I2=0%). One trial suggested an increase in the adenoma detection rate - plus (RR 4.39, 95% CI 2.91-6.61; P<.001). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for the advanced adenoma detection rate and cancer detection rate, respectively. CONCLUSIONS The current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the polyp detection rate, adenoma detection rate, and sessile serrated adenoma detection rate. However, further trials are warranted to determine the efficacy of EPE for advanced adenoma detection rate, adenoma detection rate - plus, and cancer detection rate because of limited data.

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Polyp Detection Rate as a Surrogate for Adenoma and Sessile Serrated Adenoma/Polyp Detection Rates

Gastrointestinal Tumors ◽

10.1159/000505622 ◽

2020 ◽

Vol 7 (3) ◽

pp. 74-82 ◽

Cited By ~ 1

Author(s):

Leonardo Zorron Cheng Tao Pu ◽

Gurfarmaan Singh ◽

Khizar Rana ◽

Masanao Nakamura ◽

Takeshi Yamamura ◽

...

Keyword(s):

Detection Rate ◽

Polyp Detection ◽

Sessile Serrated Adenoma ◽

Serrated Adenoma ◽

Detection Rates ◽

Polyp Detection Rate

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553 Comparison of Adenoma Detection Rate (ADR) and Sessile Serrated Polyp Detection Rate (SSP-DR) Between Small Volume Split Dose Bowel Preparation (Small-SDP) and Large Volume Split Dose Preparation (Large-SDP)

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.116 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB84-AB85 ◽

Cited By ~ 1

Author(s):

Hassan A. Siddiki ◽

Ayman R. Fath ◽

Sreya Ravi ◽

Francisco C. Ramirez ◽

Michael D. Crowell ◽

...

Keyword(s):

Bowel Preparation ◽

Large Volume ◽

Detection Rate ◽

Small Volume ◽

Adenoma Detection Rate ◽

Polyp Detection ◽

Split Dose ◽

Serrated Polyp ◽

Polyp Detection Rate ◽

Adenoma Detection

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Enhanced Patient Education for Colonic Polyp and Adenoma Detection: Meta-Analysis of Randomized Controlled Trials

JMIR mhealth and uhealth ◽

10.2196/17372 ◽

2020 ◽

Vol 8 (6) ◽

pp. e17372

Author(s):

Xu Tian ◽

Ling-Li Xu ◽

Xiao-Ling Liu ◽

Wei-Qing Chen

Keyword(s):

Detection Rate ◽

Meta Analysis ◽

Adenoma Detection Rate ◽

Advanced Adenoma ◽

Polyp Detection ◽

Sessile Serrated Adenoma ◽

Serrated Adenoma ◽

Polyp Detection Rate ◽

Adenoma Detection ◽

Number Of Patients

Background To improve patients’ comprehension of bowel preparation instructions before colonoscopy, enhanced patient education (EPE) such as cartoon pictures or other visual aids, phone calls, mobile apps, multimedia education and social media apps have been proposed. However, it is uncertain whether EPE can increase the detection rate of colonic polyps and adenomas. Objective This meta-analysis aimed to evaluate the efficacy of EPE in detecting colonic polyps and adenomas. Methods We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from their inception to June 2019 for the identification of trials comparing the EPE with standard patient education for outpatients undergoing colonoscopy. We used a random effects model to calculate summary estimates of the polyp detection rate (defined as the number of patients with at least one polyp divided by the total number of patients undergoing selective colonoscopy), adenoma detection rate (defined as the number of patients with at least one adenoma divided by the total number of patients undergoing selective colonoscopy), advanced adenoma detection rate (defined as the number of patients with at least one advanced adenoma divided by the total number of patients undergoing selective colonoscopy), sessile serrated adenoma detection rate (defined as the number of patients with at least one sessile serrated adenoma divided by the total number of patients undergoing selective colonoscopy), cancer detection rate (defined as the number of patients with at least one cancer divided by the total number of patients undergoing selective colonoscopy), or adenoma detection rate - plus (defined as the number of additional adenomas found after the first adenoma per colonoscopy). Moreover, we conducted trial sequential analysis (TSA) to determine the robustness of summary estimates of all primary outcomes. Results We included 10 randomized controlled trials enrolling 4560 participants for analysis. The meta-analysis suggested that EPE was associated with an increased polyp detection rate (9 trials; 3781 participants; risk ratio [RR] 1.19, 95% CI 1.05-1.35; P<.05; I2=42%) and adenoma detection rate (5 trials; 2133 participants; RR 1.37, 95% CI 1.15-1.64; P<.001; I2=0%), which were established by TSA. Pooled result from the inverse-variance model illustrated an increase in the sessile serrated adenoma detection rate (3 trials; 1248 participants; odds ratio 1.76, 95% CI 1.22-2.53; P<.05; I2=0%). One trial suggested an increase in the adenoma detection rate - plus (RR 4.39, 95% CI 2.91-6.61; P<.001). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for the advanced adenoma detection rate and cancer detection rate, respectively. Conclusions The current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the polyp detection rate, adenoma detection rate, and sessile serrated adenoma detection rate. However, further trials are warranted to determine the efficacy of EPE for advanced adenoma detection rate, adenoma detection rate - plus, and cancer detection rate because of limited data.

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