The quality of colon cleansing is a major determinant of quality of colonoscopy.
The impact of bowel preparation on the quality of colonoscopy has not been assessed prospectively in a large multicenter study.
Dr Froehlich and colleagues from Switzerland assessed the factors that determine colon-cleansing quality and the impact of cleansing quality on the technical performance and diagnostic yield of colonoscopy.
21 centers from 11 countries participated in this prospective observational study.
The researchers assessed colon-cleansing quality on a 5-point scale and categorized it on 3 levels.
The investigators then recorded the clinical indication for colonoscopy, diagnoses, and technical parameters related to colonoscopy.
The research team included a total of 5,832 patients in the study, with 49% men and a mean age of 58 years.
Cleansing quality was reported by the researchers to be lower in elderly patients and in patients in the hospital.
Procedures in poorly prepared patients were longer, more difficult, and more often incomplete.
The team noted that the detection of polyps of any size depended on cleansing quality, with an odds ratio of 1.7 for intermediate-quality compared with low-quality preparation; and 1.5 for high-quality compared with low-quality preparation.
In addition, it was observed that for polyps more than 10 mm in size, corresponding odds ratios were 1.0 for low-quality cleansing, 1.8 for intermediate-quality cleansing, and 1.7 for high-quality cleansing.
The investigators found that cancers were not detected less frequently in the case of poor preparation.
Dr Froehlich concluded that, “Cleansing quality critically determines quality, difficulty, speed, and completeness of colonoscopy, and is lower in hospitalized patients and patients with higher levels of comorbid conditions.”
“The proportion of patients who undergo polypectomy increases with higher cleansing quality, whereas colon cancer detection does not seem to critically depend on the quality of bowel preparation.”