The impact of bowel cleansing on follow-up recommendations in average-risk patients with a normal colonoscopy.
OBJECTIVE
Repeat colonoscopy in 10 years after a normal screening colonoscopy is recommended in an average-risk patient, and it has been proposed by American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), and American Society for Gastrointestinal Endoscopy (ASGE) as a quality measure. However, there are little quantitative data about adherence to this recommendation or factors that may improve adherence. Our study quantifies adherence to this recommendation and the impact of suboptimal bowel preparation on adherence.


METHODS
In this retrospective database study, endoscopy reports of average-risk individuals ≥50 years old with a normal screening colonoscopy were reviewed. Quality of colon cleansing was recorded using the Aronchick scale as excellent, good, fair, or poor. Main outcome measurements were quality of bowel preparation and recommendation for timing of repeat colonoscopy. Recommendations were considered consistent with guidelines if 10-year follow-up was documented after excellent, good, or fair prep or if ≤1-year follow-up was recommended after poor prep.


RESULTS
Among 1,387 eligible patients, recommendations for follow-up colonoscopy inconsistent with guidelines were seen in 332 (23.9%) subjects. By bowel preparation quality, 15.3% of excellent/good, 75% of fair, and 31.6% of poor bowel preparations were assigned recommendations inconsistent with guidelines (P<0.001). Patients with fair (odds ratio=18.0; 95% confidence interval 12.0-28.0) were more likely to have recommendations inconsistent with guidelines compared with patients with excellent/good preps.


CONCLUSIONS
Recommendations inconsistent with guidelines for 10-year intervals after a normal colonoscopy occurred in >20% of patients. Minimizing "fair" bowel preparations may be a helpful intervention to improve adherence to these recommendations.
Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Stacy B
SB
Menees
Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Eric
E
Elliott
Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Shail
S
Govani
Division of Gastroenterology, Case Western Reserve University Hospital, Cleveland, Ohio, USA.
Constantinos
C
Anastassiades
Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA.
Stephanie
S
Judd
Division of Gastroenterology, Ann Arbor Veterans' Administration Hospital, Chicago, Illinois, USA.
Annette
A
Urganus
Department of Internal Medicine, Duke University, Durham, North Carolina, USA.
Suzanna
S
Boyce
1] Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA [2] Division of Gastroenterology, Ann Arbor Veterans' Administration Hospital, Chicago, Illinois, USA.
Philip
P
Schoenfeld
D000328:Adult; D000368:Aged; D002400:Cathartics; D003113:Colonoscopy / Q000592:standards* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000517:prevention & control; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D007507:Therapeutic Irrigation / Q000592:standards*; D013997:Time Factors; D014481:United States
D002400:Cathartics