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Assessing bowel preparation quality using the mean number of adenomas per colonoscopy
Grace Clarke Hillyer1, Benjamin Lebwohl2, Richard M Rosenberg3
1Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA.
Introduction:
The quality of the bowel preparation directly influences colonoscopy effectiveness. Quality indicators are widely employed to monitor operator performance and to gauge colonoscopy effectiveness. Some have suggested that the enumeration of the mean number of adenomas per colonoscopy (MNA) may be a more useful measure of bowel preparation quality, but evidence of the utility of this metric is limited. The relationship between bowel preparation quality and MNA was assessed.
Methods:
Records of adult patients, aged 50-74 years, who had undergone a screening colonoscopy in a 6 month period at a hospital-based endoscopy suite in New York City were examined. Excluded were those who were symptomatic or having a colonoscopy for surveillance. Patient and procedural characteristics and clinical findings were abstracted from the endoscopy database. Bowel preparation quality was recorded as excellent, good, fair and poor. Histology and size of polyps removed were gathered from pathology reports. MNA was calculated and incident rate ratios assessing the relationship between bowel preparation quality, MNA, and covariates was calculated using Poisson regression.
Results:
A total of 2422 colonoscopies were identified; 815 (33.6%) were screening colonoscopies among average risk individuals, 50-74 years; 203 (24.9%) had ≥1 adenomas; and 666 (81.7%) had excellent/good preparation quality. Overall MNA was 0.34 [standard deviation (SD) 0.68] and MNA was greater among those >60 years [incident rate ratio (IRR) 1.89, 95% confidence interval (CI) 1.48-2.42), males (IRR 1.60, 95%CI 1.26-2.04) and those with good bowel preparation (IRR 2.54, 95%CI 1.04-6.16). Among those with ≥1 adenomas, MNA was 1.48 (SD 1.05) for excellent and 1.00 (SD 0.00) for poor quality preparation (p = 0.55).
Conclusions:
We found that MNA is sensitive to changes in bowel preparation with higher MNA among those with good bowel preparation compared with those with poor preparation. Our evidence suggests MNA was particularly sensitive when restricted to only those in whom adenomas were seen.
Insights
Mean number of adenomas per colonoscopy (MNA) can indicate bowel preparation quality. Higher MNA was observed with better bowel preparation, especially in patients with adenomas, suggesting MNA
Area of Science:
- Gastroenterology
- Endoscopy
- Preventive Medicine
Background:
- Colonoscopy effectiveness is significantly impacted by the quality of bowel preparation.
- Quality indicators are standard for monitoring colonoscopy performance.
- Mean number of adenomas per colonoscopy (MNA) is proposed as a metric for bowel preparation quality, but evidence is limited.
Purpose of the Study:
- To assess the relationship between bowel preparation quality and the mean number of adenomas per colonoscopy (MNA).
- To evaluate the utility of MNA as an indicator of bowel preparation quality in screening colonoscopies.
Main Methods:
- Retrospective analysis of screening colonoscopies in average-risk adults aged 50-74 years.
- Bowel preparation quality categorized as excellent, good, fair, or poor.
- Calculation of MNA and use of Poisson regression to analyze associations with preparation quality and other covariates.
Main Results:
- Overall MNA was 0.34; higher MNA was associated with older age, male sex, and good bowel preparation.
- Among patients with adenomas, MNA was 1.48 for excellent preparation versus 1.00 for poor preparation.
- MNA demonstrated sensitivity to bowel preparation quality, particularly in adenoma detection.
Conclusions:
- Mean number of adenomas per colonoscopy (MNA) is sensitive to variations in bowel preparation quality.
- MNA appears to be a valuable indicator, especially when analyzing data from patients with detected adenomas.
- Findings support the potential utility of MNA in assessing and improving colonoscopy quality.
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