Original article
Clinical endoscopy
Inadequate Boston Bowel Preparation Scale scores predict the risk of missed neoplasia on the next colonoscopy

Presented at Digestive Disease Week, May 16-19, 2015, Washington, DC (Gastrointest Endosc 2015;81:AB155).
https://doi.org/10.1016/j.gie.2017.06.012Get rights and content

Background and Aims

The risks of missed findings after inadequate bowel preparation are not fully characterized in a diverse cohort. We aimed to evaluate the likelihood of missed polyps after an inadequate preparation as assessed by using the Boston Bowel Preparation Scale (BBPS).

Methods

In this observational study of prospectively collected data within a large, national, endoscopic consortium, we identified patients aged 50 to 75 years who underwent average-risk screening colonoscopy (C1) followed by a second colonoscopy for any indication within 3 years (C2). We determined the polyp detection rates (PDRs) and advanced PDRs during C2 stratified by C1 BBPS scores.

Results

Among segment pairs without polyps at C1 (N = 601), those with inadequate C1 BBPS segment scores had a higher PDR at C2 (10%) compared with those with adequate bowel preparation at C1 (5%; P = .04). Among segment pairs with polyps at C1 (N = 154), segments with inadequate bowel preparation scores at C1 had higher advanced PDRs at C2 (20%) compared with those with adequate bowel preparation scores at C1 (4%; P = .03). In multivariable analysis, the presence of advanced polyps at C1 (adjusted odds ratio [OR] 3.5; 95% confidence intervals [CIs], 1.1-10.8) but not inadequate BBPS scores at C1 (adjusted OR 1.8; 95% CI, 0.6-5.1) was associated with a significantly increased risk of advanced polyps at C2.

Conclusions

Inadequate BBPS segment scores generally are associated with higher rates of polyps and advanced polyps at subsequent colonoscopy within a short timeframe. The presence of advanced polyps as well as inadequate BBPS segment scores can inform the risk of missed polyps and help triage which patients warrant a timely repeat colonoscopy.

Section snippets

Methods

This study was approved by the Institutional Review Board with waiver of informed consent at Boston Medical Center in November 2010.

Results

Between 2009 and 2014 there were approximately 98,000 average-risk screening colonoscopies performed within CORI, of which 11,177 (11%) included a BBPS score. Among the examinations with a BBPS score, 365 (3%) had 2 procedures within the database. These 365 average-risk screening C1 examinations were performed by 99 different CORI endoscopists from 29 different practice groups. At least 24 of the endoscopists (24%) completed the on-line BBPS educational program.22 Of these 365 examinations, 335

Discussion

In this study of a consortium of endoscopy units throughout the United States, we found that in cases without baseline polyps detected, colon segments with BBPS segments scores of 0 or 1 compared with those with scores of 2 or 3 had higher rates of polyps on subsequent examinations, and, similarly, in cases without baseline polyps detected, colon segments with BBPS segment scores of 0 or 1 compared with BBPS scores of 2 or 3 had higher rates of advanced polyps on subsequent examination within 3

Acknowledgments

The authors would like to thank Tor D. Tosteson, ScD and Zhongze Li, MS, for their help in portions of the analysis.

References (26)

  • A.H. Calderwood et al.

    Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness

    Gastrointest Endosc

    (2014)
  • B.T. Clark et al.

    Quantification of adequate bowel preparation for screening or surveillance colonoscopy in men

    Gastroenterology

    (2016)
  • R.L. Siegel et al.

    Cancer statistics, 2015

    CA Cancer J Clin

    (2015)
  • Cited by (0)

    DISCLOSURE: D. Lieberman was the executive director of the Clinical Outcomes Research Initiative (CORI), a nonprofit organization supporting this study. This potential conflict of interest has been reviewed and managed by the Oregon Health & Science University and Veterans Affairs Conflict of Interest in Research Committee. D. Lieberman and CORI are supported with funding from National Institutes of Health and National Institute of Diabetes and Digestive and Kidney Diseases grants NIDDK U01, DK057132, R33-DK61778-01, and R21-CA131626. A. Calderwood received grant NIH K08 DK090150-05. Funding from NIDDK supports the collection, management, analysis, and interpretation of this and all CORI research. In addition, the practice network (CORI) has received support for the infrastructure of the practice-based network from AstraZeneca, Bard International, Pentax USA, ProVation, Endosoft, Given Imaging, and Ethicon. The commercial entities had no involvement in this research. The funder had no role in study design, data collection, interpretation, or publication of this manuscript. All other authors disclosed no financial relationships relevant to this publication.

    If you would like to chat with an author of this article, you may contact Dr Calderwood at [email protected].

    View full text