title: Shortened surveillance intervals following suboptimal bowel preparation for colonoscopy: results of a national survey.
abstract: OBJECTIVE
  Suboptimal bowel preparation can result in decreased neoplasia detection, shortened surveillance intervals, and increased costs. We assessed bowel preparation recommendations and the relationship to self-reported proportion of suboptimal bowel preparations in practice; and evaluated the impact of suboptimal bowel preparation on colonoscopy surveillance practices. A random sample of a national organization of gastroenterologists in the U.S. was surveyed.
  
  
  METHODS
  Demographic and practice characteristics, bowel preparation regimens, and proportion of suboptimal bowel preparations in practice were ascertained. Recommended follow-up colonoscopy intervals were evaluated for optimal and suboptimal bowel preparation and select clinical scenarios.
  
  
  RESULTS
  We identified 6,777 physicians, of which 1,354 were randomly selected; 999 were eligible, and 288 completed the survey. Higher proportion of suboptimal bowel preparations/week (≥10 %) was associated with hospital/university practice, teaching hospital affiliation, >25 % Medicaid insured patients, recommendation of PEG alone and sulfate-free. Those reporting >25 % Medicare and privately insured patients, split dose recommendation, and use of MoviPrep® were associated with a <10 % suboptimal bowel preparations/week. Shorter surveillance intervals for three clinical scenarios were reported for suboptimal preparations and were shortest among participants in the Northeast who more often recommended early follow-up for normal findings and small adenomas. Those who recommended 4-l PEG alone more often advised <1 year surveillance interval for a large adenoma.
  
  
  CONCLUSIONS
  Our study demonstrates significantly shortened surveillance interval recommendations for suboptimal bowel preparation and that these interval recommendations vary regionally in the United States. Findings suggest an interrelationship between dietary restriction, purgative type, and practice and patient characteristics that warrant additional research.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA. gah28@columbia.edu
authors.forename: Grace Clarke
authors.initials: GC
authors.lastname: Hillyer
authors.forename: Corey H
authors.initials: CH
authors.lastname: Basch
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
authors.forename: Charles E
authors.initials: CE
authors.lastname: Basch
authors.forename: Fay
authors.initials: F
authors.lastname: Kastrinos
authors.forename: Beverly J
authors.initials: BJ
authors.lastname: Insel
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000328:Adult; D002400:Cathartics; D003113:Colonoscopy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D057566:Self Report; D013997:Time Factors; D014481:United States
chemical_list: D002400:Cathartics