Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 3994-3999
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3994
Importance of reporting segmental bowel preparation scores during colonoscopy in clinical practice
Deepanshu Jain, Mojdeh Momeni, Mahesh Krishnaiah, Sury Anand, Shashideep Singhal
Deepanshu Jain, Internal Medicine Department, Albert Einstein Medical Centre, PH 19141, United States
Mojdeh Momeni, Mahesh Krishnaiah, Sury Anand, Shashideep Singhal, Division of Gastroenterology, Department of Internal Medicine, The Brooklyn Hospital Centre, Brooklyn, NY 11205, United States
Shashideep Singhal, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Centre at Houston, Houston, TX 77030, United States
Author contributions: Jain D contributed to enrolling patients, compiling results and writing up manuscript; Momeni M and Krishnaiah M contributed to enrolling patients; Anand S contributed to enrolling patients, supervising study progress, and editing the manuscript; and Singhal S contributed to study design, supervising study progress, analysing data, editing the manuscript.
Ethics approval: The study was reviewed and approved by The Brooklyn Hospital Centre Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed verbal consent prior to study enrolment.
Conflict-of-interest: None of the authors disclosed any conflict of interest.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shashideep Singhal, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Centre at Houston, 6431 Fannin Street, MSB 4.234, Houston, TX 77030, United States. sdsinghal@gmail.com
Telephone: +1-713-5006683 Fax: +1-713-5006699
Received: August 31, 2014
Peer-review started: September 1, 2014
First decision: September 15, 2014
Revised: October 25, 2014
Accepted: January 8, 2015
Article in press: January 8, 2015
Published online: April 7, 2015
Processing time: 219 Days and 17 Hours
Abstract

AIM: To evaluate the impact of reporting bowel preparation using Boston Bowel Preparation Scale (BBPS) in clinical practice.

METHODS: The study was a prospective observational cohort study which enrolled subjects reporting for screening colonoscopy. All subjects received a gallon of polyethylene glycol as bowel preparation regimen. After colonoscopy the endoscopists determined quality of bowel preparation using BBPS. Segmental scores were combined to calculate composite BBPS. Site and size of the polyps detected was recorded. Pathology reports were reviewed to determine advanced adenoma detection rates (AADR). Segmental AADR’s were calculated and categorized based on the segmental BBPS to determine the differential impact of bowel prep on AADR.

RESULTS: Three hundred and sixty subjects were enrolled in the study with a mean age of 59.2 years, 36.3% males and 63.8% females. Four subjects with incomplete colonoscopy due BBPS of 0 in any segment were excluded. Based on composite BBPS subjects were divided into 3 groups; Group-0 (poor bowel prep, BBPS 0-3) n = 26 (7.3%), Group-1 (Suboptimal bowel prep, BBPS 4-6) n = 121 (34%) and Group-2 (Adequate bowel prep, BBPS 7-9) n = 209 (58.7%). AADR showed a linear trend through Group-1 to 3; with an AADR of 3.8%, 14.8% and 16.7% respectively. Also seen was a linear increasing trend in segmental AADR with improvement in segmental BBPS. There was statistical significant difference between AADR among Group 0 and 2 (3.8% vs 16.7%, P < 0.05), Group 1 and 2 (14.8% vs 16.7%, P < 0.05) and Group 0 and 1 (3.8% vs 14.8%, P < 0.05). χ2 method was used to compute P value for determining statistical significance.

CONCLUSION: Segmental AADRs correlate with segmental BBPS. It is thus valuable to report segmental BBPS in colonoscopy reports in clinical practice.

Keywords: Colorectal cancer screening; Adenomas; Polyps; Boston Bowel Preparation Score

Core tip: Bowel preparation quality determines the yield of colonoscopy. Most endoscopists continue to use the subjective systems of reporting bowel preparation. Boston Bowel Preparation Score (BBPS) helps to understand segment-specific risks for missed pathology based on the degree of bowel cleanliness. Our study showed that segmental Advanced Adenoma detection rate correlate with segmental BBPS. Segmental reporting will help in careful examination during repeat colonoscopy of segments with poor or sub-optimal BBPS on previous colonoscopy, in determining appropriate surveillance interval and the procedure for surveillance and in determining appropriate interventions to improve bowel preparation for colonoscopy in future.