Mary B. White, BS1, Rachel N. Israilevich, BS1, Sophia Lam, BS1, Benjamin Chipkin, MS1, David Kastenberg, MD2; 1Sidney Kimmel Medical College, Philadelphia, PA; 2Thomas Jefferson University Hospital, Philadelphia, PA
Introduction: Direct Access Colonoscopy (DAC), which does not require pre-colonoscopy consultation, may improve access for patients (pts) needing screening and surveillance. Eligibility criteria for DAC vary widely. We developed a DAC program using data (age, BMI, medical/colonoscopy/social history, medications) from the EMR, referring doctors, and pts to assess appropriateness, inadequate preparation (prep) risk, and need for an advanced practice nurse and/or navigator. The aim of this study was to evaluate the efficacy, efficiency, and quality of our DAC program. Methods: We conducted a retrospective, single center study of consecutive pts referred for DAC over 13 months. Pts were age 45-75 with an indication of screening or surveillance. Excluded were pts with symptoms or pre-colonoscopy consultation. The primary endpoint was Complete Colonoscopy (CC): To cecum/ileum/anastomosis, adequate prep (BBPS > 2 all segments), < 90 days from contact with the GI office. Pts not meeting CC criteria were classified as Incomplete Colonoscopy (IC). Secondary endpoints: Time to CC, adenoma detection rate (ADR), and 10-year recall rate after negative screening colonoscopy. Statistics: Descriptive analyses for the DAC cohort, t-test and chi-square for CC and IC group comparisons. Results: 1,668 pts met inclusion criteria. Mean age was 58, 57% were female, 65% were non-White/Other, and 86% neither Hispanic nor Latino. The indication was screening in 90% and surveillance in 10%. Following contact with the GI office for DAC, 1,042 pts (62%) met the endpoint of CC with an average interval of 35.74 days. The CC group had a mean BBPS of 7.94 with 91% using a PEG-ELS prep, an ADR of 38%, and a 10-year recall rate of 82% after a negative exam. Reasons for IC were pt cancellation (35%), no show (28%), inadequate prep (9%), scheduled > 90 days (8%), other cancelation (7%), insurance/financial (4%), medical clearance (4%), and other (5%). Table 1 presents comparisons between the CC and IC groups. Blacks were less likely than non-Blacks (57% vs. 68%; p < 0.001), and non-Whites less likely than Whites (59% vs. 69%; p < 0.001), to have a CC. A surveillance indication was more common in the CC group (12% vs. 6%; p < 0.001). Discussion: About 2/3 of pts referred for DAC had a CC within 90 days, and both ADR and BBPS were high. Failure to attend colonoscopy accounted for most ICs, with few excluded for inadequate prep. Blacks were less likely, and Whites more likely, to have a CC. A surveillance indication was associated with a CC.
Table 1: Patient characteristics.
Disclosures: Mary White indicated no relevant financial relationships. Rachel Israilevich indicated no relevant financial relationships. Sophia Lam indicated no relevant financial relationships. Benjamin Chipkin indicated no relevant financial relationships. David Kastenberg: Medtronic – Consultant, Grant/Research Support. Motus GI – Consultant, Grant/Research Support.