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Am J Gastroenterol. 2007 Dec;102(12):2680-5. Epub 2007 Aug 21.

The impact of colon cleanliness assessment on endoscopists' recommendations for follow-up colonoscopy.

Author information

1
Department of Gastroenterology, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.

Abstract

OBJECTIVE:

Repeat colonoscopy is advocated for low-quality preparations. However, there are few data on how endoscopists assess the quality of bowel preparation. We aimed to investigate, in a visually reproducible manner, endoscopists' assessment of colon cleanliness, as reflected by their subsequent recommendations for follow-up.

METHODS:

Gastroenterologists attending the Israeli Gastroenterology Association meeting were presented with photographs depicting varying degrees of colon cleanliness at a hypothetical screening colonoscopy. Endoscopists were requested to denote their recommendation for the timing of a follow-up procedure for each of the different preparations, both when no polyps were detected and when two small adenomas were found.

RESULTS:

Seventy-eight gastroenterologists were included. There was considerable interobserver variability in endoscopists' assessment of preparation adequacy, and recommended follow-up timing ranged from more than 5 yr to immediate repeat colonoscopy for identical preparations. Interestingly, even when repeat colonoscopy was not considered necessary, most endoscopists recommended progressively shorter follow-up intervals in line with reduced preparation quality (mean interval dropping from 9.2+/-1.7 to 6.3+/-2.8 to 2.5+/-2 yr, P<0.001 for trend). Similar findings were observed when two adenomas were hypothetically found on the index procedure, although follow-up intervals were shorter. No correlation was found between endoscopists' clinical experience or acquaintance with clinical guidelines and their actual recommendation.

CONCLUSIONS:

Clinical decisions derived from colon cleanliness assessment vary considerably among endoscopists, and there is little agreement on what constitutes a disqualifying preparation. Moreover, when confronted with an intermediate-quality preparation, most gastroenterologists recommend a shorter follow-up interval, rather than repeating the procedure. Further studies are required to validate this management approach and to standardize the assessment of preparation quality.

[Indexed for MEDLINE]

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