The Quality of Bowel Preparation After Bariatric Surgery: Diverse Effects of Diversion

Obesity and the metabolic syndrome are well-known risk factors for colon cancer [1‐3]. The prevalence of serrated and conventional adenomas is higher in persons with obesity, the risk increasing with BMI [4‐6]. In terms of colorectal cancer (CRC) screening programs, endoscopy in this population can be challenging, with adherence to the screening programs suboptimal, especially for individuals with higher BMIs [7]. Multiple factors are responsible for the suboptimal uptake of endoscopy in the morbidly obese; among them, embarrassment, weight-related stigmata, and associated co-morbidities that increase sedation and procedural risk are prominent. Moreover, obesity could reduce the quality of bowel preparation, though findings are heterogeneous [8]. The quality of the bowel preparation is an essential parameter for a satisfactory adenoma detection rate for screening colonoscopy. It is also possible that obstacles to achieving a high-quality bowel prep may diminish adherence to screening programs. Far from being irrelevant given the higher risk of cancer in the several million obese people worldwide, attention to the quality of the bowel prep in this population is worthwhile of further study. …