Improving the Quality of Colonoscopy Bowel Preparation With a Fellow-Based Colonoscopy Clinic

Abstract

Introduction: To evaluate the impact of a dedicated, fellow-based colonoscopy clinic on screening colonoscopy quality metrics. Methods: Beginning July 2013, all patients referred for screening colonoscopy to the fellow-staffed clinic at our institution were scheduled for a dedicated ambulatory visit during which a gastroenterology fellow described the procedure and reviewed in detail a split-dose preparation for the examination with the assistance of an interpreter as needed. Prior to this intervention, referred patients had received only a letter with the date and time of their examination and preparation instructions. As part of our standard colonoscopy protocol, the quality of the bowel preparation was recorded by the endoscopist using the Aronchick scale (denoting excellent, good, fair, or poor). We investigated the quality of bowel prep and adenoma detection rate (ADR) in patients who underwent a screening colonoscopy in the 6 months prior to the intervention (Group 1) and those during the 6-month period after the intervention (Group 2). Results: A total of 127 screening colonoscopies were identified, with 69 in Group 1 and 58 in Group 2. Mean age at time of colonoscopy was 55.7± 6.29 years and 57.2± 7.17 years in Groups 1 and Group 2, respectively (p=0.21). Both groups were predominantly female, though with a higher proportion in Group 2 (52.17% in Group 1 and 70.7% in Group 2, p=0.03). Preparation quality was analyzed in the 124 procedures that included this data in the endoscopy report. Using an ordered logistic regression model, Group 2 had more than a 2-fold greater odds of having an excellent or good bowel preparation compared to Group 1 (OR 2.11; 95% CI 1.04, 4.28; p=0.038). There was no significant difference in ADR observed between the 2 groups, with adenomas detected in 31.88% in Group 1 and 41.38% in Group 2 (p=0.27). Conclusion: A fellow-based clinic dedicated to reviewing colonoscopy preparation appears to significantly improve bowel preparation. Larger studies are needed to confirm this finding and investigate if such an intervention would also improve ADRs.