Outcomes of Next Day Colonoscopy Versus Non-next Day Colonoscopy After Initial Colonoscopy With Inadequate Bowel Preparation

Abstract

Introduction: To evaluate the outcomes of repeat colonoscopy after initial inadequate bowel prep when follow-up exam was performed the next day vs. any other day (“non-next day”). Inadequate bowel preparation is the most common cause of repeat colonoscopy in screening and surveillance programs. Inadequate prep occurs in more than 20% of repeated attempts. Limited data suggest a reduced risk for inadequate prep when the follow-up exam is performed the next day; however, substantial endoscopy resources maybe required if next day examination is truly the preferred option for patients after inadequate bowel prep. Methods: Records from the University of Utah from July 2002-2012 were reviewed for screening and surveillance colonoscopies with documented inadequate prep as defined by Aronchick scale. For 5 years after each initial inadequately prepped colonoscopy, records were searched for a repeat exam categorized as either next day or non-next day follow-up. Outcome measures were prep quality, and polyp and adenoma (total and ≥1cm) detection rates. Groups were compared using Student’s t and Chi-square tests as appropriate. Results: Of 20,798 total colonoscopies, 857 had inadequate prep (4%); 460 (54%) were lost to follow-up. Three hundred ninety-seven (46%) had a repeat colonoscopy, of which 114 (29%) were next day, and 283 (71%) non-next day, with a mean follow-up time of 8.8±12.0 months. Prep quality improved on repeat exams, however there was no significant difference in prep quality between next day vs. non-next day procedures (p=0.48). In the next day group, polyp detection per procedure improved from 0.08 initially to 1.17 on follow-up, compared to 0.64 and 1.51 in non-next day procedures. The adenoma detection rate for the next day group improved from 3.5% initially to 38.6% on follow-up, compared to 20.5% and 36.8% in the non-next day group. Conclusion: The results confirm the need for repeat examination after a colonoscopy with inadequate bowel prep, as there was a substantial increase in total polyp and adenoma detection on subsequent procedures. There were no differences in outcomes between next day vs. non-next day follow-up, which supports performing a repeat examination within 1 year as convenient for patient and physician. Disclosure - Dr. Fang - Consultant: Boston Scientific. Dr. Fang - Consultant: Merit Medical. Dr. Fang - Chief Scientific Officer: Veritract. Dr. Samadder - Consultant: Wilson-Cook Medical. Dr. Samadder - Consultant: Coviden.Table 1