1. GASTROINTESTINAL ENDOSCOPY Volume 78, No. 3 : 2013 F1 김태영
Stacy B. Menees, MD, MS, H. Myra Kim, ScD, Eric E. Elliott, MPH, Jennifer L. Mickevicius, BS,Brittany B. Graustein, BS, Philip S. Schoenfeld, MD, MSEd, MSc
Ann Arbor, Michigan, USA
GASTROINTESTINAL ENDOSCOPY Volume 78, No. 3 : 2013
F1 김태영

2. INTRODUCTION CRC -2nd cause of cancer-related deaths in US
Colonoscopy : identify and prevent CRC
Early detection and prevention through polypectomy
53% reduction in long-term mortality
(National Polyp Study)
Adequate bowel cleansing is crucial
2012 CRC guideline (US-MSTF)
poor =>within 1 yr
fair but adequate (adenoma < 1 cm); F/U 5 years

3. INTRODUCTION F/U data of inadquate bowel prep. – limited
Lebwohl et al 27% adenoma miss rate
Chokshi et al 33.8% adenoma miss rate
Impact of fair bowel preparation on endoscopists’
recommendations ?
Findings on repeat colonoscopy ?

4. Aronchick Bowel Preparation Scale (ABPS)
REV ESP ENFERM DIG (Madrid) Vol N.° 8, pp , 2012

5. Ottawa Bowel Preparation Scale (OBPS,2004)
REV ESP ENFERM DIG (Madrid) Vol N.° 8, pp , 2012

6. Boston Bowel Preparation Scale (BBPS,2010)
REV ESP ENFERM DIG (Madrid) Vol N.° 8, pp , 2012

7. METHODS-Study population
Retrospective review of EMR, database
University of Michigan medical procedure unit
and 2 university outpatient ambulatory centers
Age: 50 ~ 65 yrs , ~
Preparation qualities rated as fair
GI symptoms, family or personal history of CRC
hereditary CRC syndrome, IBD, incomplete
colonoscopies => excluded

8. METHODS- F/U recommendations
Numerous recommendation available
Multiple recommendations
(eg, if adenoma, then repeat in 2 years
hyperplastic and/or benign polyps at 10 years and
adenomatous polyps at 3 or 5 years )

9. METHODS- F/U colonoscopy compliance
A 1-year lag of F/U colonoscopy was added to data
Recommendations ≥ 5 years were not included
Lost to follow-up , excluded

10. METHODS-Adenoma detection & miss rate
The adenoma detection rate
: the percentage of patients , ≥1 adenoma
The adenoma miss rate (all size, optimal prep.)
: A/ A+B
A = total number of patients with adenomas of F/U within 3 years
B = total number of patients with adenomas , on the index colonoscopy
Optimal prep: excellent, good, adquate

11. METHODS- Patient and procedure data
Demographic and clinical data
: patient age, sex, race, BMI, concurrent narcotic
usage, and DM status
Colonoscopy procedure data
: number, size, and histology, procedural difficulty
completion status
Endoscopist-level (ie, years in clinical practice, sex)
data not collected

12. METHODS- Statistical analysis
Analysis of variance and χ² tests
Reported F/U recommendation intervals and compliance by categorical colonoscopy findings
Statistical analyses, performed by using SAS 9.2

13. RESULTS 2004. 7.1 ~ 2006. 6. 30 , N=16,251 colonoscopy
N=1943 (indication of average-risk or screening)
N=619 (fair bowel preparation)
Adenoma detection rate, index colonoscopy : 20.5%

15. RESULTS F/U colonoscopy recommendations
70.4% recommended for a repeat colonoscopy within 5 years, total
77.9% recommended for a repeat colonoscopy within 5 years, with polyp
98.0% recommended for a repeat colonoscopy within 5 years, 1-2 small
adenoma

16. RESULTS F/U colonoscopy compliance
N= 619 (fair bowel prep. in index colonoscopy)
N= 145 (23.4%) a recommended F/U ≤3 yrs
N= 71 (55.9%) compliance to F/U ≤3 yrs

17. RESULTS F/U colonoscopy compliance
N= 619 (fair bowel prep. in index colonoscopy)
N= 436 (70.4%) a recommended F/U ≤5 yrs
N= 183 (53.7%) compliance to F/U ≤5 yrs

18. RESULTS 3-yrs adenoma detection & miss rates
N= 619 (fair bowel prep. in index colonoscopy)
N= 71 (55.9%) compliance to F/U ≤3 yrs
N= 39 optimal bowel prep.
N= 11 (28.2%) ≥1 adenoma
13.6% normal on index colonoscopy

20. DISCUSSION 2012 USMSTF , No consensus for Fair prep.
2006 Gastroenterology guideline
: 1-2 adenoma , F/U 5-10 yrs
only 13% follow guideline
Retrospective study, information quality limited
Variability reporting of fair prep ,among physician
Generalizability performed in an academic setting

21. CONCLUSION
Fair bowel preparation leads to early repeat colonoscopy follow-up recommendations.
70% of patients with repeat colonoscopy within 3 years show 28% adenoma miss rate.
Further guidelines on timing for repeat colonoscopy for fair bowel preparation are needed.