title: The outcome of a second preparation for colonoscopy after preparation failure in the first procedure.
abstract: BACKGROUND
  There are scant data regarding the outcome of consecutive repeated procedures in patients who failed to adequately clean their colon for colonoscopy.
  
  
  OBJECTIVE
  To investigate the outcome of a second colonoscopy after preparation-associated failure of the first colonoscopy.
  
  
  METHODS
  A retrospective study in a tertiary-referral center.
  
  
  METHODS
  All patients with failure of colonoscopy because of poor preparation within a 1-year period.
  
  
  RESULTS
  Of a total of 6990 colonoscopies performed during the study period, 307 procedures (4.4%) failed because of inadequate preparation. Data on subsequent repeated colonoscopies were available for 235 patients. The repeated procedure again failed because of unsatisfactory preparation in 54 of these patients (23%). The failure rate in subsequent third and fourth colonoscopies was also high (more than 25%). Of the various patient and procedure-related parameters examined, only the use of calcium channel blockers (CCB) was found to be predictive of a failed repeated preparation (odds ratio [OR] 3.2 [95% CI, 1.6-6.3], P < .001). In contrast, a next-day colonoscopy after failure of the index procedure was associated with a reduced risk of unsatisfactory second preparation (OR 0.31 [95% CI, 0.1-0.92], P = .03).
  
  
  CONCLUSIONS
  Validated data on the specific bowel purgatives used were not available.
  
  
  CONCLUSIONS
  Almost a fourth of patients with an unacceptable colonic preparation will also fail the repeated colonoscopy, and patients who use CCB are at particular risk for failure. Strategies to manage this difficult-to-treat patient group should be investigated and may possibly include a preference for next-day colonoscopy.
authors.affiliation: Current affiliations: Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel. sben-horin@013.net.il
authors.forename: Shomron
authors.initials: S
authors.lastname: Ben-Horin
authors.forename: Simon
authors.initials: S
authors.lastname: Bar-Meir
authors.forename: Benjamin
authors.initials: B
authors.lastname: Avidan
mesh_terms: D002400:Cathartics; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies
chemical_list: D002400:Cathartics