Aims:
Effective colonoscopy requires successful bowel preparation. ‘Adequate’ preparation
allows detection of lesions > 5 mm and has been defined as a Boston Bowel Preparation
Scale (BBPS) score of ≥2 per segment. This post hoc analysis determined the relationship
between BBPS scores and adenoma and polyp detection rates in patients who had identical
scores in each of the three colon segments, using pooled data from three identically
designed Phase 3, multicentre, randomised trials.
Methods:
Analysed patients had: treatment-blinded central reader assessed BBPS scores where
the BBPS score was identical in each segment; and recorded polyp and adenoma counts.
Patients were stratified to assess the relationship between low-quality cleansing
(BBPS of 1+1+1), adequate cleansing (BBPS of 2+2+2) or high-quality cleansing (BBPS
of 3+3+3), and ADR and PDR. A logistic regression (LR) model was fitted to assess
whether ≥1 polyps and, separately, ≥1 adenomas, were detected including the BBPS score
group and study as fixed effects.
Results:
1170 patients were analysed (Table 1). For low, adequate and high-quality cleansing,
the PDRs were: 40.7%, 41.7%, 54.8%, and the ADRs were: 27.8%, 26.0% and 42.8%. The
odds ratio (OR) for detection were significantly higher with high-quality versus adequate
cleansing (PDR OR: 1.60, 95% confidence interval [CI] 1.14 – 2.24, P = 0.0067; ADR
OR: 1.97, 95% CI 1.39 – 2.80, P = 0.0001). LR analysis revealed a significant correlation
between BBPS score and PDR (P = 0.0239) and ADR (P = 0.0006).
Tab. 1:
PDR and ADR by uniform BBPS score
|
Overall colon lesion detection rates
|
High-Quality (N = 166)
|
Adequate (N = 950)
|
Low-Quality (N = 54)
|
Odds ratio High-Quality: Adequate (95% CI) [P-value]
|
Odds ratio Adequate: Low-Quality (95% CI) [P-value]
|
|
PDR, n (%)
|
91 (54.8)
|
396 (41.7)
|
22 (40.7)
|
1.60 (1.14 – 2.24) [0.0067]
|
0.90 (0.50 – 1.60) [0.7104]
|
|
ADR, n (%)
|
71 (42.8)
|
247 (26.0)
|
15 (27.8)
|
1.97 (1.39 – 2.80) [0.0001]
|
0.75 (0.39 – 1.43) [0.3829]
|
|
LR Analysis of Association between Uniform BBPS Score Group and PDR, P-value
|
0.0239
|
|
LR Analysis of Association between Uniform BBPS Score Group and ADR, P-value
|
0.0006
|
Conclusions:
In patients who had uniform low, adequate or high-quality cleansing in each respective
colon segment, there was a strong correlation between higher cleansing scores and
increased PDR and ADR.
