Skip Navigation
Skip to contents

Intest Res : Intestinal Research

Search
Advanced Search
IMPACT FACTOR
mobile search button mobile menu button

Articles

Page Path
HOME > Intest Res > Volume 13(4); 2015 > Article
Letter to the Editor Author's Reply
Hoonsub So1, Seungbong Han2, Dong-Hoon Yang1
Intestinal Research 2015;13(4):364-364.
DOI: https://doi.org/10.5217/ir.2015.13.4.364
Published online: October 15, 2015

1Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

2Department of Applied Statistics, Gachon University, Seongnam, Korea.

Correspondence to Dong-Hoon Yang, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-5809, Fax: +82-2-3010-6517, dhyang@amc.seoul.kr
• Received: September 8, 2015   • Revised: September 15, 2015   • Accepted: September 15, 2015

© Copyright 2015. Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev
  • 5,040 Views
  • 38 Download
Full Article

Download PDF Download PDF

We would like to express our gratitude to Dr. Kang for his interest and comments.1 Our study was prompted by curiosity over whether objective evaluation of rectal effluent by using photographic examples would improve prediction of the quality of a bowel preparation.2 As Dr. Kang pointed out, our study has several limitations. First, it is difficult to apply in actual practice. Patients would be inconvenienced by having to remember the extent of the last three rectal effluents, and physicians would have the difficult task of educating patients, assessing total points, and determining the necessity of an additional preparation. However, as Fatima et al. reported, there is some agreement between the patient's description of rectal effluent and the bowel preparation quality.3 In our study as well, the score of the last rectal effluent did not differ between two groups (1.41±0.56 in the optimal group and 1.61±0.72 in the suboptimal group, P=0.111). Therefore, we made the effort to assist patients in evaluating their last three rectal effluents. We agree with Dr. Kang that the method is complicated and difficult to apply to the general population. Second, there is ambiguity in the photographic examples, especially between B, C, and D. The number of photographs may be narrowed down from five examples to four, to reduce this ambiguity. However, the main point of our study is that photographic examples may enhance the predictive value of a bowel preparation by using rectal effluent. Lastly, considering the cost of colonoscopy and difficulty for a patient to undergo reexamination, setting a cut-off point at higher sensitivity for detection of a suboptimal preparation could be more important than the specificity. When we set the cutoff point at 11, the sensitivity, specificity, positive predictive value, and negative predictive value would be 4.5%, 100%, 100%, and 69.1%, respectively. However, only 2 of 44 patients showing suboptimal bowel preparation were rectal effluent score ≥11. This means that changing cut-off point to maximize the specificity may increase unnecessary trials of colonoscopic examinations for the patients whose actual bowel preparation status is very likely to be suboptimal. Moreover, when we conducted receiver operating characteristic analysis, the value under the curve for discriminating a suboptimal bowel preparation was only 0.608, which is not an acceptable value for clinical use. We believe that a better method should be investigated for prediction of suboptimal bowel preparation in the future.

Financial support: None.

Conflict of interest: None.

  • 1. Kang HW. Patient description of rectal effluents with photographic examples as a predictive indicator for the quality of bowel preparation. Intest Res 2015;13:362–363.ArticlePubMedPMC
  • 2. So H, Boo SJ, Seo H. Patient descriptions of rectal effluents may help to predict the quality of bowel preparation with photographic examples. Intest Res 2015;13:153–159.PMID: 25932000.ArticlePubMedPMC
  • 3. Fatima H, Johnson CS, Rex DK. Patients' description of rectal effluent and quality of bowel preparation at colonoscopy. Gastrointest Endosc 2010;71:1244–1252.PMID: 20362286.ArticlePubMed

Figure & Data

REFERENCES

    Citations

    Citations to this article as recorded by  

      • PubReader PubReader
      • ePub LinkePub Link
      • Cite
        CITE
        export Copy Download
        Close
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
        Format:
        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        Include:
        • Citation for the content below
        Author's Reply
        Intest Res. 2015;13(4):364-364.   Published online October 15, 2015
        DOI: https://doi.org/10.5217/ir.2015.13.4.364
        Close
      • XML DownloadXML Download
      Author's Reply
      Author's Reply
      Intest Res : Intestinal Research
      © Korean Association for the Study of Intestinal Diseases.
      Close layer
      TOP