Abdul Al-Douri, MD1, Deepak Agrawal, MD1, Michael Pignone, MD, MPH1, David Tang, MD2, Nicole Kluz, MPH1; 1University of Texas, Austin, TX; 2University of Texas at Austin - Dell Medical School, Austin, TX
Introduction: Colorectal cancer is the 3rd leading cause of death in the US. Colonoscopy is the most commonly used diagnostic tool in our arsenal and more than 15 million are performed annually in the US. In 2012, The US Multi-Society Task Force on Colorectal Cancer guidelines for the first time mentioned poor preparation and recommended repeat examination within 1 year in most cases of poor bowel preparation. Methods: We performed a retrospective review of inpatient and outpatient electronic health records at Dell Seton Medical Center and CommUnityCare (CUC), a large safety net health care system in Austin, Texas to describe rates of inadequate bowel preparation. We identified 1709 eligible patients between ages 50-75 within the safety net system who had evidence of colonoscopy within the past 10 years. 204 of 1709 (12%) patients had suboptimal bowel prep, identified as fair or poor. Each chart was reviewed to determine what the recommended interval was for repeat testing was, whether it was performed, and whether any further intervention was necessary. Results: Of the 204 patient who had suboptimal prep, 109 (53%) were deemed to be in need of a colonoscopy or fecal immunochemical test (FIT) as no follow-up was done.Those patients were classified into increased risk (personal or family history of CRC, adenomatous polyps or polyps with dysplasia or FIT positive) or average risk (no risk factors). Average risk patients were sent FIT test kits, while increased risk patients were contacted and scheduled for colonoscopies. Of the 109, 67 (61%) were deemed to need FIT testing, 24 (22%) were in need of colonoscopies now, 9 (8%) were in need of colonoscopies in the future, 6 (5%) patients were out of CUC system, and 3 (3%) were >75 years old and over age of recommended screening. Of the 41 patients overdue for colonoscopy that we were able to contact, 4 (0.1%) of those patients were found with cancer or high-grade dysplasia. Discussion: Healthcare providers must be aware of patients with poor bowel prep, particularly in a safety net setting. Poorly prepared colons result in a longer cecal intubation time, a lower cecal intubation rate, higher adenoma miss rate (AMR), as well as increase in total costs to healthcare system. Therefore, gastroenterologists should develop a call back or a reminder system and should educate patients about need for repeat colonoscopies in those poor prep.
Figure 1: Schematic Representation of Follow-up for Patients with History of Poor Prep Colonoscopy
Disclosures: Abdul Al-Douri indicated no relevant financial relationships. Deepak Agrawal indicated no relevant financial relationships. Michael Pignone indicated no relevant financial relationships. David Tang indicated no relevant financial relationships. Nicole Kluz indicated no relevant financial relationships.