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Shortened surveillance intervals following suboptimal bowel preparation for colonoscopy: Results of a national survey

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Suboptimal bowel preparation can result in decreased neoplasia detection, shortened surveillance intervals, and increased costs. We assessed bowel preparation recommendations and the relationship to self-reported proportion of suboptimal bowel preparations in practice; and evaluated the impact of suboptimal bowel preparation on colonoscopy surveillance practices. A random sample of a national organization of gastroenterologists in the U.S. was surveyed.

Methods

Demographic and practice characteristics, bowel preparation regimens, and proportion of suboptimal bowel preparations in practice were ascertained. Recommended follow-up colonoscopy intervals were evaluated for optimal and suboptimal bowel preparation and select clinical scenarios.

Results

We identified 6,777 physicians, of which 1,354 were randomly selected; 999 were eligible, and 288 completed the survey. Higher proportion of suboptimal bowel preparations/week (≥10 %) was associated with hospital/university practice, teaching hospital affiliation, >25 % Medicaid insured patients, recommendation of PEG alone and sulfate-free. Those reporting >25 % Medicare and privately insured patients, split dose recommendation, and use of MoviPrep® were associated with a <10 % suboptimal bowel preparations/week. Shorter surveillance intervals for three clinical scenarios were reported for suboptimal preparations and were shortest among participants in the Northeast who more often recommended early follow-up for normal findings and small adenomas. Those who recommended 4-l PEG alone more often advised <1 year surveillance interval for a large adenoma.

Conclusions

Our study demonstrates significantly shortened surveillance interval recommendations for suboptimal bowel preparation and that these interval recommendations vary regionally in the United States. Findings suggest an interrelationship between dietary restriction, purgative type, and practice and patient characteristics that warrant additional research.

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Acknowledgments

This work was supported by a National Cancer Institute at the National Institutes of Health fellowship (R25 CA094601) to C.H. Basch; a National Center for Research Resources (NCRR) at the National Institutes of Health grant (KL2 RR024157) to B. Lebwohl; American Cancer Society (RSGT-09-012-01-CPPB) grant to C.E. Basch; and National Cancer Institute at the National Institutes of Health (K07 151769) grant to F. Kastrinos.

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Authors and Affiliations

  1. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY, 10032, USA

    Grace Clarke Hillyer, Beverly J. Insel & Alfred I. Neugut

  2. Department of Public Health, William Paterson University, Wayne, NJ, USA

    Corey H. Basch

  3. Division of Digestive and Liver Diseases, Columbia University, New York, NY, USA

    Benjamin Lebwohl & Fay Kastrinos

  4. Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Benjamin Lebwohl, Charles E. Basch, Fay Kastrinos & Alfred I. Neugut

  5. Department of Health & Behavior Studies, Teachers College, Columbia University, New York, NY, USA

    Charles E. Basch

  6. Division of Hematology and Oncology of the Department of Medicine, Columbia University, New York, NY, USA

    Alfred I. Neugut

Authors
  1. Grace Clarke Hillyer
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  2. Corey H. Basch
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  3. Benjamin Lebwohl
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  4. Charles E. Basch
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  5. Fay Kastrinos
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  6. Beverly J. Insel
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  7. Alfred I. Neugut
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Correspondence to Grace Clarke Hillyer.

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Hillyer, G.C., Basch, C.H., Lebwohl, B. et al. Shortened surveillance intervals following suboptimal bowel preparation for colonoscopy: Results of a national survey. Int J Colorectal Dis 28, 73–81 (2013). https://doi.org/10.1007/s00384-012-1559-7

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  • DOI: https://doi.org/10.1007/s00384-012-1559-7

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