S1243 Superior Quality Indicators for Colonoscopies Scheduled by Open Access Compared to GI-Office: It Is Time to Expand Its Use During the COVID-19 Crisis!

Abstract

INTRODUCTION: Open access (OA) colonoscopies are defined as those scheduled without a GI office visit. OA is becoming more routine, as it can decrease cost of unnecessary office consultations. One issue related to OA procedures is patient acceptance and preparedness for procedures. However, there is limited research on adequacy of bowel preparation (BP), patient compliance, and detection of adenomas in OA colonoscopies. METHODS: This study was a cross-sectional study of 60 patients using split BP for colonoscopies. Patient consent was obtained, and surveys were administered before procedures. Patient age, BMI, gender, education level, prior c-scope and constipation history were collected. Patient compliance with the prep was self-reported. BP adequacy and adenomas detected were recorded. Adequate BP was defined as excellent and good, and inadequate BP was defined as fair and poor. Patients were asked three questions on a scale from 1 to 5 qualifying the BP instructions (Table 1). 5 indicated complete agreement with the statement and 1 indicated no agreement. SPSS was utilized to analyze the data using chi square and Mann-Whitney tests. RESULTS: Complete data for BP adequacy was collected for 56/60 patients. 21 participants (38%) were scheduled by OA, and 35 participants (62%) were scheduled after GI-office visit. Adequate BP was more frequent in 86% (18/21) of patients in the OA group compared to 60% (21/35) of patients in the GI-office group (P = 0.043). Patients in the OA group had higher self-reported compliance and adenoma detection but were not significant (Figure 1). There was no statistical difference between the OA and GI-office groups for age, BMI, gender, education level, history of constipation, and prior c-scope (Table 2). OA group patients reported better review and explanation of the BP instructions compared to GI-office patients. No statistical difference was found in how well the patients understood the importance of BP (Table 1). CONCLUSION: This study has shown that OA colonoscopies were associated with more adequate bowel preparation. This could be explained by patients' self-motivation or more time spent reviewing and explaining the significance of completing BP. This study supports the use of OA procedures as a standard of care, especially during the COVID-19 pandemic, which is causing a significant disruption in normal office operations. It also supports the notion that BP adequacy may start with spending sufficient time discussing split prep instructions with patients.Figure 1.: Quality of bowel prep, patient self-reported compliance, and adenomas detection among the Open access group and GI office group . 86% of patients in the OA group had adequate bowel prep compared to 60% of patients in the GI-office group (P = 0.532). 73% of patients in the OA group were compliant compared to 65% of patients in the GI-office group. (P = 0.043). 38% of patients in the OA group had adenomas detected compared to 28% of patients in the GI-office group (P = 0.419).Table 1.: Mean rank and P-values comparing OA vs GI-office for the 3 qualifying questions regarding comprehension of Bowel Prep instructionsTable 2.: Demographics of patient population