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Bonne ou mauvaise préparation colique : quels risques pour le patient et quels scores ou échelles pour le gastroentérologue ?

Good or inadequate bowel preparation: what are the risks for the patient and what score or scales to use for the gastroenterologist?

  • Point de Vue de l’Expert / Expert’s Point of View
  • Published:
Acta Endoscopica

Résumé

La qualité de la préparation colique est un facteur de variation du taux de détection des polypes toutes tailles confondues ou de diamètre inférieur ou égal à 9 mm, mais discutée pour les lésions de taille supérieure ou égale à 9 mm. Il n’existe pas de démonstration que la qualité de la préparation constitue un facteur indépendant de survenue de CCR d’intervalle. L’évaluation et la description de la qualité de la préparation se heurtent à des échelles d’utilisation paraissant simples mais peu ou moyennement reproductibles et surtout non encore corrélées de façon exhaustive et prospective au taux de détection des polypes ou adénomes. Cela suggère que les échelles de Boston ou de Harefield doivent être adoptées mais avant tout validées prospectivement pour être opposables. Le taux de détection des lésions varie en fonction du score de Boston et est associé à une différence de détection des polypes avec une détection factuelle des polypes égale à 40 et 24 % pour un score de Boston, respectivement supérieur ou égal à 5 ou inférieur à 5 et une probabilité de détection des polypes de plus de 5 mm « estimée par les experts » à 88 % s’il est supérieur ou égal à 7 et de 100 % pour un score supérieur ou égal à 8. Pour un score de Harefield classé en classe A, B, C ou D, la détection des adénomes est respectivement et effectivement égale à 26, 26, 25 et 0 % alors qu’en classant les préparations coliques de type satisfaisant (classe A ou B) et non satisfaisant (classe C ou D), ce pourcentage de détection des adénomes était égal à 26,1 vs 22,3 % (ns).

Abstract

The quality of bowel preparation is a factor in the variation of the detection rate for polyps of all sizes or with a diameter ≤ 9 mm, but is debatable for lesions greater than or equal to 9 mm in size. It has not been demonstrated that the quality of the preparation is an independent factor in the occurrence of interval CRC (colorectal cancer). The evaluation and the description of the quality of the preparation comes up against the scales, which appear to be simple to use, but only have average reproducibility at best, and are not yet fully correlated with or planned for the detection rate of polyps and adenomas. This suggests that the Boston or Harefield scale should be adopted, but first of all validated prospectively, so that they are applicable. The lesion detection rate varies for the Boston Scale, and is associated with a difference in the detection of polyps with an evidence-based detection equal to 40% and 24% for a Boston score of ≥ 5 or < 5 respectively and a probability of detection for polyps < 5 mm “estimated by the experts” of 88% if the score is ≥ 7 and 100% for a score ≥ 8. For a Harefield score classified as A, B, C or D, the detection of adenomas is effectively equal to 26%, 26%, 25% and 0% respectively when bowel preparation is classed as being satisfactory (class A or B) and if non-satisfactory (C or D) this detection rate for adenomas is equal to 26.1% versus 22.3% (ns).

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  1. Unité d’endoscopie et de consultation digestive, CHG de Redon, F-35600, Redon, France

    D. Heresbach

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Heresbach, D. Bonne ou mauvaise préparation colique : quels risques pour le patient et quels scores ou échelles pour le gastroentérologue ?. Acta Endosc 44, 3–10 (2014). https://doi.org/10.1007/s10190-013-0364-7

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  • DOI: https://doi.org/10.1007/s10190-013-0364-7

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