Bowel Prep Matters in CRC Outcomes

Bowel preparation rated by the endoscopist as fair or lower on the Aronchick Scale was associated with not only fewer adenomas detected, but also with higher risk of death from colorectal cancer postcolonoscopy, Austrian researchers found.

The investigators reported in the American Journal of Gastroenterology that few large studies have been published that reviewed the association between quality of bowel preparation and long-term colorectal cancer outcomes among patients who underwent screening. The researchers analyzed records of 335,466 colonoscopies in a population-based screening program database, conducted from January 2012 and followed until December 2022.

The endoscopist ranked quality of bowel preparation according to the Aronchick Scale as excellent, good, fair, poor, or inadequate. “We used logistic regression to assess the influence of bowel preparation on the detection of different polyp types and the interphysician variation in bowel preparation scoring,” the authors wrote. “Time-to-event analyses were performed to investigate the association of bowel preparation with postcolonoscopy colorectal cancer (PCCRC) death.”

Adenoma detection was not significantly lower for good bowel preparation (odds ratio 1.01, 95% confidence interval [CI] 0.9971–1.0329, P = 0.1023) compared to excellent, they noted. “However, adenoma detection was significantly lower in fair bowel preparation (odds ratio 0.97, 95% CI 0.9408–0.9939, P = 0.0166). Individuals who had fair or lower bowel preparation at screening colonoscopy had significantly higher hazards for PCCRC death (hazard ratio for fair bowel preparation 2.56, 95% CI 1.67–3.94, P < 0.001).”

Reference:

Zessner-Spitzenberg J, Waldmann E, Rockenbauer L, et al. Impact of bowel preparation quality on colonoscopy findings and colorectal cancer deaths in a nation-wide colorectal cancer screening program. Am J Gastroenterol. 2024;119(10):2036-2044. DOI: 10.14309/ajg.0000000000002880