Inadequate Bowel Preparation Increases Missed Polyps

Recently, the demand of colonoscopy has been increasing rapidly due to the social interest for screening of colorectal cancer (CRC).This phenomenon is associated with the fact that colonoscopy is the most useful method for the detection and removal of colorectal polyps and that colonoscopic polypectomy significantly reduces the incidence and mortality of CRC.1,2 Although there are several screening modalities available for CRC, colonoscopy is considered the most effective method due to the ability of immediate polypectomy and biopsy of abnormal findings.Despite these remarkable features, the effectiveness of colonoscopy on the unconverted mortality of proximal colon cancer and the development of interval cancer are still in question.In addition, previous tandem colonoscopy studies reported the miss rates ranging from 12% to 24% for overall adenomas and between 0% and 6% for adenomas of ≥1 cm.3,4 Although most colonoscopists already expect that polyps can be missed during colonoscopy, these results suggest that colonoscopy is no more infallible for the detection of colorectal neoplasms.In order to obtain clear image during colonoscopy, adequate colon preparation, defined as the ability to detect polyps of 5 mm or larger, 5 is essential.If bowel preparation is poor, it leads to prolonged examination time, incomplete procedure, and more importantly, missed significant lesions.Suboptimal bowel preparation has actually taken considerable portions of all colonoscopic examinations.Recently, two studies investigated the relationship between missing polyps and suboptimal bow-