Interval to Repeat Average Risk Screening Colonoscopy in Patients with Inadequate Bowel Preparation Varies Widely among Practicing Gastroenterologists

Abstract

Purpose: Colorectal cancer (CRC) is the third leading cause of cancer-related mortality in the U.S. Inadequate bowel preparation (IBP) with sub-optimal endoscopic visualization limits the impact of screening colonoscopy in identifying neoplasia.1-2 Current ACG/AGA/ASGE Multi-Society Task Force (MSTF) CRC screening guidelines suggest repetition of colonoscopy within 12 months when IBP is encountered, with exceptions made for “fair but adequate” preparations where the endoscopist feels comfortable in detecting neoplasia >5 mm in size.3 The aim of this survey is to assess physician practice patterns regarding the recommended interval to repeat screening colonoscopy found to have IBP. Methods: A multiple-choice survey was distributed to all physicians at the Florida Gastroenterologic Society annual postgraduate meeting. This survey asked physicians to select the appropriate interval to repeat colonoscopy for patients found to have an IBP at baseline average-risk screening colonoscopy when 1.) no polyps were found, 2.) one tubular adenoma 5 mm in diameter was encountered, and 3.) one tubular adenoma 10 mm in diameter was encountered. Participants were also asked to estimate the percentage of screening colonoscopies with IBP encountered in their clinical practices. Results: Twenty of 178 surveys were returned. 25% of respondents reported IBP in greater than 10% of screening colonoscopies. Overall, the most frequently recommended interval for repeat colonoscopy was within three months. Repeat colonoscopy within three months was recommended by 50% of respondents if no polyp was encountered, 40% when a 5-mm tubular adenoma was found, and 55% when a 10-mm tubular adenoma was discovered. Twelve of 20 (60%) physicians elected to repeat the colonoscopy within 12 months when either no polyp or a single 5-mm tubular adenoma was identified. Five of 20 (20%) respondents chose to wait more than one year to repeat the colonoscopy when a tubular adenoma 10 mm in size was identified. A further study to increase sample size is currently being conducted. Conclusion: GI physicians commonly repeat colonoscopy for IBP within 3 months, regardless of the findings at baseline, average-risk screening colonoscopy. A high degree of variability was noted in the responses, with some GIs waiting as long as 5 years to repeat screening in the presence of an adenoma with IBP. Awareness of MSTF recommendations or adherence to these guidelines is poor among GI physicians. Publicity of guidelines and further data to support their recommendations are warranted.