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Background: The quality of colon cleansing is a major determinant of quality o f colonoscopy. To our knowledge, the impact of bowel preparation on the quality of colonoscopy has not been assessed prospectively in a large multicenter study. There fore, this study assessed the factors that determine coloncleansing qualit y and the impact of cleansing quality on the technical performance and diagnosti c yield of colonoscopy.Methods: Twenty-one centers from 11 countries participat ed in this prospective observational study. Colon-cleansing quality was assesse d on a 5-point scale and was categorized on 3 levels.The clinical indication fo r colonoscopy, diagnoses, and technical parameters related to colonoscopy were r ecorded. Results:A total of 5832 patients were included in the study (48.7%men, mean age 57.6 [15.9] years). Cleansing quality was lower in elderly patients and in patients in the hospital. Procedures in poorly prepared patients were longer , more difficult, and more often incomplete. The detection of polyps of any size depended on cleansing quality: odds ratio (OR) 1.73: 95%confidence interval(CI )[1.28, 2.36] for intermediate-quality compared with low-quality preparation; and OR 1.46: 95%CI[1.11, 1.93]for high-quality compared with low-quality pr eparation. For polyps >10 mm in size, corresponding ORs were 1.0 for low-qualit y cleansing, OR 1.83: 95%CI[1.11, 3.05] for intermediate-quality cleansing, an d OR 1.72: 95%CI[1.11,2.67] for high-quality cleansing. Cancers were not detec ted less frequently in the case of poor preparation. Conclusions:Cleansing quali ty critically determines quality,difficulty, speed,and completeness of colonosco py, and is lower in hospitalized patients and patients with higher levels of com orbid conditions.The proportion of patients who undergo polypectomy increases wi th higher cleansing quality, whereas colon cancer detection does not seem to cri tically depend on the quality of bowel preparation.
Background: The quality of colon cleansing is a major determinant of quality of colonoscopy. To our knowledge, the impact of bowel preparation on the quality of colonoscopy has not been assessed prospectively in a large multicenter study. There fore, this study assessed the factors that determine coloncleansing qualit y and the impact of cleansing quality on the technical performance and diagnosti c yield of colonoscopy. Methods: Twenty-one centers from 11 countries participat ed in this prospective observational study. Colon-cleansing quality was assesse d on a 5-point scale and was categorized on 3 levels. The clinical indication fo r colonoscopy, diagnoses, and technical parameters related to colonoscopy were r ecorded. Results: A total of 5832 patients were included in the study (48.7% men, mean age 57.6 [15.9] Cleansing quality was lower in elderly patients and in patients in the hospital. Procedures in poorly prepared patients were longer, more difficult, and more often inc omplete. The detection of polyps of any size depended on cleansing quality: odds ratio (OR) 1.73: 95% confidence interval (CI) [1.28, 2.36] for intermediate-quality compared with low- For polyps> 10 mm in size, corresponding ORs were 1.0 for low-qualit y cleansing, OR 1.83: 95% CI [1.11, 3.05] for intermediate -quality cleansing, an d OR 1.72: 95% CI [1.11,2.67] for high-quality cleansing. Cancers were not detec ted less frequently in the case of poor preparation. Conclusions: Cleansing quali ty critically determines quality, difficulty, speed, and completeness of colonosco py, and is lower in hospitalized patients and patients with higher levels of com orbid conditions. proportion of patients who undergo polypectomy increases wi th higher cleansing quality, incorporating colon cancer detection does not seem to cri tically depend on the quality of bowel preparation.