PTH-028 Higher-quality colon cleansing improves lesion detection during colonoscopy: a quantitative analysis of phase 3 trials
Year: 2019
Type: conference-paper
Abstract: Introduction Colon cleansing is important for reliable lesion detection during colonoscopy, however the quantitative benefits of improved cleansing quality remain poorly understood. This post hoc analysis of three similarly designed phase 3 randomised clinical trials assessed the treatment-independent trends for overall colon cleansing quality versus overall colon lesion detection. Methods Three multi-centre phase 3 clinical trials compared the cleansing efficacy and safety of the 1L PEG NER1006 (PLENVU®) versus standard bowel preparations in patients aged 18–85 years. Treatment-blinded assessment of colon cleansing quality was performed by both site colonoscopists (SC; who also detected all lesions per local practice) and by central readers (CR). Two validated cleansing scales were used: the Harefield Cleansing Scale (HCS) and the Boston Bowel Preparation Scale (BBPS; only by CR). Patients with documented HCS cleansing grades D-A, overall BBPS scores 0–9, and overall colon lesion counts were included in this analysis. Logistic regression trends were fitted to polyp- (PDR) and adenoma (ADR) detection rates, using cleansing quality as a covariate. Results Out of 1,985 randomised patients, 1,749 patients were included (table 1). With site colonoscopists’ HCS grades, the logistic regression for relative lesion detection demonstrated an odds ratio of 1.17, i.e. for each incremental increase in the HCS colon cleansing grade from D to A there was a 1.17 times increase in both PDR (P=0.009) and ADR (P=0.019). With central readers, the corresponding increase was 1.24 times for PDR (P=0.005) and 1.26 times for ADR (P=0.006). With central readers, each incremental increase in the successful BBPS scores 6–9 resulted in a 1.08 times increase in PDR (P<0.001) and 1.10 times increase in ADR (P<0.001) versus failing BBPS scores 0–5. Conclusions Adopting a better bowel preparation remains a good way to improve quality in colonoscopy. With both HCS and BBPS, an increased overall colon cleansing quality was associated with greater overall colon PDR and ADR across the full range from cleansing failures and up to high-quality cleansing.
Source: Gut
Authors: Andrew Holgate, Soniya Mokashi, Jonathan Manning
Institutions: Norgine (United Kingdom), Borders General Hospital
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3022006151