Gastroenterology Department, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain.
Clinical Pharmacology Department, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, CIBERehd, Alicante, Spain.
Endoscopy. 2020 Dec;52(12):1093-1100. doi: 10.1055/a-1191-3011. Epub 2020 Jun 24.
Current guidelines regarding surveillance after screening colonoscopy assume adequate bowel preparation. However, follow-up intervals after suboptimal cleansing are highly heterogeneous. We aimed to determine the diagnostic yield of early repeat colonoscopy in patients with suboptimal bowel preparation in fecal immunochemical test (FIT)-based screening colonoscopy.
An observational study including patients who underwent colonoscopy with suboptimal bowel preparation after positive FIT screening and then repeat colonoscopy within 1 year. Suboptimal preparation was defined as a Boston Bowel Preparation Scale (BBPS) score of 1 in any segment. Patients with a BBPS score of 0 in any segment or incomplete examination were excluded. The adenoma detection rate (ADR), advanced ADR (AADR), and colorectal cancer rate were calculated for the index and repeat colonoscopies.
Of the 2474 patients with FIT-positive colonoscopy at our center during this period, 314 (12.7 %) had suboptimal preparation. Of the 259 (82.5 %) patients who underwent repeat colonoscopy, suboptimal cleansing persisted in 22 (9 %). On repeat colonoscopy, the ADR was 38.7 % (95 %CI 32.6 % to 44.8 %) and the AADR was 14.9 % (95 %CI 10.5 % to 19.4 %). The per-adenoma miss rate was 27.7 % (95 %CI 24.0 % to 31.6 %), and the per-advanced adenoma miss rate was 17.6 % (95 %CI 13.3 % to 22.7 %). After repeat colonoscopy, the post-polypectomy surveillance recommendation changed from 10 to 3 years in 14.7 % of the patients with previous 10-year surveillance recommendation.
Patients with suboptimal bowel preparation on FIT-positive colonoscopy present a high rate of advanced adenomas in repeat colonoscopy, with major changes in post-polypectomy surveillance recommendations.
目前关于筛查结肠镜检查后监测的指南假设肠道准备充分。然而，次优清洁后的随访间隔时间高度异质。我们旨在确定粪便免疫化学试验（FIT）筛查结肠镜检查中肠道准备不佳的患者进行早期重复结肠镜检查的诊断效果。
一项观察性研究包括在 FIT 筛查阳性后接受肠道准备不佳的结肠镜检查并在 1 年内进行重复结肠镜检查的患者。肠道准备不佳定义为任何部位的波士顿肠道准备量表（BBPS）评分 1。任何部位 BBPS 评分 0 或检查不完整的患者被排除在外。计算索引和重复结肠镜检查的腺瘤检出率（ADR）、高级 ADR（AADR）和结直肠癌发生率。
在此期间，我们中心进行的 FIT 阳性结肠镜检查患者中有 2474 例（12.7%）肠道准备不佳。在 259 例（82.5%）接受重复结肠镜检查的患者中，22 例（9%）持续肠道清洁不佳。在重复结肠镜检查中，ADR 为 38.7%（95%CI 32.6%至 44.8%），AADR 为 14.9%（95%CI 10.5%至 19.4%）。每个腺瘤的漏诊率为 27.7%（95%CI 24.0%至 31.6%），每个高级腺瘤的漏诊率为 17.6%（95%CI 13.3%至 22.7%）。重复结肠镜检查后，14.7%之前建议进行 10 年监测的患者，其息肉切除术后监测建议从 10 年更改为 3 年。
FIT 阳性结肠镜检查肠道准备不佳的患者在重复结肠镜检查中存在较高的高级腺瘤发生率，并导致息肉切除术后监测建议发生重大变化。
