The informed consent of patients was waived because of the retrospective nature of the study. This study was approved by the Institutional Review Board at Kangbuk Samsung Hospital and was conducted according to the Declaration of Helsinki (KBSMC 2). In this study, we sought to determine the risk factors for IBP surveillance colonoscopy after colorectal resection. Bowel preparation for surveillance colonoscopies has received relatively little attention. Accurately quantifying and assessing reasons for poor bowel preparation is difficult as such, few studies on bowel preparation for surveillance colonoscopy have been performed compared to colonoscopy studies focused on histopathologic results or ideal time period between colonoscopies. Nonevacuated bowels may occur for various reasons, including inability to completely evacuate the bowel due to decreased bowel motility after surgery and reduced compliance of bowel preparation because of repeated tests. Ī large amount of liquid fecal material was often found in the colon when surveillance colonoscopies were performed on patients who underwent colorectal resection, despite the fact that patients had been educated on bowel preparation and reported intake of all bowel preparation medications. In addition, adequate bowel preparation is essential not only for increased detection of metachronous cancers or lesions, but also to avoid unfavorable results such as cecal intubation failure or prolonged procedural time. Previous studies have shown that inadequate bowel preparation (IBP) at the time of CRC screening colonoscopies resulted in an adenoma miss rate ranging from 33% to 46%. In particular, of these prerequisites, adequate bowel preparation with no solid or liquid fecal material in the bowel mucosa plays a critical role in tumor detection. A high-quality colonoscopy assumes completeness (where the cecum or anastomosis is reached), adequate bowel preparation, and meticulous examination by appropriately trained operators who meet adenoma detection benchmarks (i.e., frequency of conventional adenoma detection >25% in average-risk screening colonoscopies). Ī critical prerequisite for surveillance colonoscopy is that the examination must be effective and of high-quality. Furthermore, the National Comprehensive Cancer Network guidelines recommend postoperative surveillance colonoscopy within the first year after CRC surgery. Based on these findings, several studies recommend that patients who undergo CRC resection should undergo a first surveillance colonoscopy one year after surgery. The current incidence rate of metachronous colon cancer ranges from 0.7% to 3.6% within 3 years postsurgery, and 90% of cancer recurrence is observed within 5 years of surgery. Recently, ways to increase surveillance colonoscopy effectiveness for early diagnosis of CRC recurrence or metachronous cancer have been investigated, with many studies focusing on the ideal time period between surgery and surveillance colonoscopy. As a result, colonoscopy has become increasingly more important as a surveillance method for the diagnostic evaluation of metachronous cancer and its recurrence. Existing studies have shown that patients that undergo a colonoscopy after CRC resection have a lower overall mortality rate and a lower risk of metachronous cancer during the perioperative period compared to those who do not undergo colonoscopy. Although no standard for surveillance has been established, it is common to combine some or all of the following techniques for effective surveillance, including physical examinations, blood carcinoembryonic antigen tests, computed tomography scans of the chest and abdomen, and endoscopy. As a result, the number of patients who underwent surveillance after colorectal resection has increased. Because of its prevalence, surgical techniques and systemic therapies have advanced over the past 20 years, and are correlated with an increase in postoperative CRC survival rate throughout most of the world (with exceptions for patients in Eastern Europe and Latin America). Colorectal cancer (CRC) is the fourth leading cause of cancer-related death in South Koreans, and the third leading cause of death worldwide.
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