The pre-colonoscopy bowel prep may not be a pleasant experience for patients, but it's a vitally important one that increases the likelihood physicians will notice precancerous polyps, according to new research released by the American Society for Gastrointestinal Endoscopy.
The study, which appears in the June issue of GIE: Gastrointestinal Endoscopy, shows that suboptimal bowel preps — researchers say they occur in more than 20% of all colonoscopies — are linked to high polyp miss rates and increased need for repeat exams, which drives up the total cost of colonoscopy.
According to the study, bowel prepping was suboptimal in 24% of the 12,787 patients reviewed, 17% of whom required a repeat exam before the recommended 3-year interval for individuals with completely excised advanced adenomas or multiple adenomas found during initial screenings with optimal prepping
Benjamin Lebwohl, MD, MS, instructor of clinical medicine at Columbia University Medical Center in New York City and lead author of the study, says his research revealed that 42% of all missed adenomas were discovered during repeat exams.
The researchers note, however, that current guidelines fail to suggest how soon patients should undergo a second screening when preps fail. They also point to a lack of consensus among physicians with respect to how soon repeat colonoscopies should be performed when inadequate bowel preps impact the effectiveness of primary screenings. Dr. Lebwohl suggests performing repeat colonoscopies for these patients within 1 year of the initial exam, even if an adenoma is discovered.
Daniel Cook
