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Evaluating the practice of canceling colonoscopies for presumed inadequate bowel preparation

Published:March 20, 2020DOI:https://doi.org/10.1016/j.gie.2020.03.3750

      Background and Aims

      Only scant data describe the practice of canceling colonoscopies before colonoscope insertion for presumed inadequate bowel preparation (PIBP). We sought to better understand the ramifications of such cancellations and to characterize the nationwide practice of cancellations for PIBP.

      Methods

      We determined the frequency of colonoscopies canceled for PIBP at our institution, assessing practice variation and whether patients who were canceled for PIBP completed colonoscopy or fecal immunohistochemical testing within 6 months. We also surveyed gastroenterology program directors to determine whether canceling colonoscopies for PIBP is commonly permitted and if such cancellations are included in calculations of bowel preparation adequacy rates.

      Results

      Three percent of patients were canceled because of PIBP at our institution, with significant provider practice variability in cancellation rates. Only 67% of patients whose cases were canceled for PIBP completed colonoscopy or fecal immunohistochemical testing within 6 months. The ability of an endoscopist to cancel a colonoscopy for PIBP was reported by 97% of survey respondents. Such cases are frequently not included in calculations of bowel preparation adequacy rates.

      Conclusions

      The ability to cancel colonoscopies because of PIBP is near ubiquitous, but such cases are not uniformly included in calculations of bowel preparation adequacy rates. Variation in provider practice, and resulting impact on patient care, suggests a need for standardized protocols. Colonoscopies canceled for PIBP should be included in calculations of bowel preparation adequacy rates.

      Abbreviation:

      PIBP (presumed inadequate bowel preparation)
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      References

        • Joseph D.A.
        • Meester R.G.S.
        • Zauber A.G.
        • et al.
        Colorectal cancer screening: estimated future colonoscopy need and current volume and capacity.
        Cancer. 2016; 122: 2479-2486
        • Radaelli F.
        • Paggi S.
        • Repici A.
        • et al.
        Barriers against split-dose bowel preparation for colonoscopy.
        Gut. 2017; 66: 1428-1433
        • Dik V.K.
        • Moons L.M.
        • Hüyük M.
        • et al.
        Predicting inadequate bowel preparation for colonoscopy in participants receiving split-dose bowel preparation: development and validation of a prediction score.
        Gastrointest Endosc. 2015; 81: 665-672
        • Govani S.M.
        • Elliott E.E.
        • Menees S.B.
        • et al.
        Predictors of suboptimal bowel preparation in asymptomatic patients undergoing average-risk screening colonoscopy.
        World J Gastroenterol. 2016; 8: 616-622
        • Cheng C.L.
        • Liu N.J.
        • Tang J.H.
        • et al.
        Predictors of suboptimal bowel preparation using 3-l of polyethylene glycol for an outpatient colonoscopy: a prospective observational study.
        Dig Dis Sci. 2017; 62: 345-351
        • Johnson D.A.
        • Barkun A.N.
        • Cohen L.B.
        • et al.
        Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer.
        Gastroenterology. 2014; 147: 903-924
        • Fatima H.
        • Johnson C.S.
        • Rex D.K.
        Patients' description of rectal effluent and quality of bowel preparation at colonoscopy.
        Gastrointest Endosc. 2010; 71: 1244-1252
        • So H.
        • Boo S.J.
        • Seo H.
        • et al.
        Patient descriptions of rectal effluents may help to predict the quality of bowel preparation with photographic examples.
        Intest Res. 2015; 13: 153-159
        • PacPhail M.E.
        • Hardacker K.A.
        • Tiwari A.
        • et al.
        Intraprocedural cleansing work during colonoscopy and achievable rates of adequate preparation in an open-access endoscopy unit.
        Gastrointest Endosc. 2015; 81: 525-530