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Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study

  • Florian Froehlich
    Correspondence
    Reprints requests: Florian Froehlich, MD, Department of Gastroenterology PMU/CHUV, University of Lausanne, Rue du Bugnon 44, CH-1011 Lausanne, Switzerland.
    Affiliations
    Current affiliations: Department of Gastroenterology PMU/CHUV, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland, Department of Gastroenterology, University of Basle, Basle, Switzerland
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  • Author Footnotes
    † Deceased.
    Vincent Wietlisbach
    Footnotes
    † Deceased.
    Affiliations
    Current affiliations: Department of Gastroenterology PMU/CHUV, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland, Department of Gastroenterology, University of Basle, Basle, Switzerland
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  • Jean-Jacques Gonvers
    Affiliations
    Current affiliations: Department of Gastroenterology PMU/CHUV, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland, Department of Gastroenterology, University of Basle, Basle, Switzerland
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  • Bernard Burnand
    Affiliations
    Current affiliations: Department of Gastroenterology PMU/CHUV, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland, Department of Gastroenterology, University of Basle, Basle, Switzerland
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  • John-Paul Vader
    Affiliations
    Current affiliations: Department of Gastroenterology PMU/CHUV, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland, Department of Gastroenterology, University of Basle, Basle, Switzerland
    Search for articles by this author
  • Author Footnotes
    † Deceased.

      Background

      The quality of colon cleansing is a major determinant of quality of colonoscopy. To our knowledge, the impact of bowel preparation on the quality of colonoscopy has not been assessed prospectively in a large multicenter study. Therefore, this study assessed the factors that determine colon-cleansing quality and the impact of cleansing quality on the technical performance and diagnostic yield of colonoscopy.

      Methods

      Twenty-one centers from 11 countries participated in this prospective observational study. Colon-cleansing quality was assessed on a 5-point scale and was categorized on 3 levels. The clinical indication for colonoscopy, diagnoses, and technical parameters related to colonoscopy were recorded.

      Results

      A total of 5832 patients were included in the study (48.7% men, mean age 57.6 [15.9] years). Cleansing quality was lower in elderly patients and in patients in the hospital. Procedures in poorly prepared patients were longer, more difficult, and more often incomplete. The detection of polyps of any size depended on cleansing quality: odds ratio (OR) 1.73: 95% confidence interval (CI)[1.28, 2.36] for intermediate-quality compared with low-quality preparation; and OR 1.46: 95% CI[1.11, 1.93] for high-quality compared with low-quality preparation. For polyps >10 mm in size, corresponding ORs were 1.0 for low-quality cleansing, OR 1.83: 95% CI[1.11, 3.05] for intermediate-quality cleansing, and OR 1.72: 95% CI[1.11, 2.67] for high-quality cleansing. Cancers were not detected less frequently in the case of poor preparation.

      Conclusions

      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.
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