Impact of inadequate bowel cleansing in sigmoidoscopy screening

Long-time follow-up of sigmoidoscopy screening trials has shown reduced incidence and mortality of colorectal cancer (CRC), but inadequate bowel cleansing may hamper efficacy. The aim of this study was to assess the impact of bowel cleansing quality in sigmoidoscopy screening. Individuals 50 to 74 y...

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Bibliographic Details
Published in:	Scandinavian journal of gastroenterology Vol. 59; no. 8; pp. 1002 - 1009
Main Authors:	Randel, Kristin Ranheim, Schult, Anna Lisa, Botteri, Edoardo, Nawaz, Mobina, Nguyen, Dung Hong, Holme, Øyvind, Bretthauer, Michael, Hoff, Geir, de Lange, Thomas
Format:	Journal Article
Language:	English
Published:	England 02-08-2024
Subjects:	Adenoma - diagnosis adenoma detection rate Aged bowel cleansing quality bowel preparation Cathartics - administration & dosage Colonoscopy - methods Colorectal cancer screening Colorectal Neoplasms - diagnosis Cross-Sectional Studies Early Detection of Cancer - methods Female Gastroenterologi Gastroenterology and Hepatology Humans key performance indicators Logistic Models Male Mass Screening - methods Middle Aged Norway Sigmoidoscopy Norway bowel preparation Colorectal cancer screening adenoma detection rate key performance indicators sigmoidoscopy bowel cleansing quality
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Summary:	Long-time follow-up of sigmoidoscopy screening trials has shown reduced incidence and mortality of colorectal cancer (CRC), but inadequate bowel cleansing may hamper efficacy. The aim of this study was to assess the impact of bowel cleansing quality in sigmoidoscopy screening. Individuals 50 to 74 years old who had a screening sigmoidoscopy in a population-based Norwegian, randomized trial between 2012 and 2019, were included in this cross-sectional study. The bowel cleansing quality was categorised as excellent, good, partly poor, or poor. The effect of bowel cleansing quality on adenoma detection rate (ADR) and referral to colonoscopy was evaluated by fitting multivariable logistic regression models. 35,710 individuals were included. The bowel cleansing at sigmoidoscopy was excellent in 20,934 (58.6%) individuals, good in 6580 (18.4%), partly poor in 7097 (19.9%) and poor in 1099 (3.1%). The corresponding ADRs were 17.0%, 16.6%, 14.5%, and 13.0%. Compared to participants with excellent bowel cleansing, those with poor bowel cleansing had an odds ratio for adenoma detection of 0.66 (95% confidence interval 0.55-0.79). We found substantial differences in the assessment of bowel cleansing quality among endoscopists. Inadequate bowel cleansing reduces the efficacy of sigmoidoscopy screening, by lowering ADR. A validated rating scale and improved bowel preparation are needed to make sigmoidoscopy an appropriate screening method. Clinicaltrials.gov (NCT01538550).
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0036-5521 1502-7708 1502-7708
DOI:	10.1080/00365521.2024.2364213