P4055 - Same Day Cancellations for Presumed Inadequate Bowel Preparation: A Quality Assessment and Initiative

Lauren L. Comer, MD¹, Prisca Pungwe, MD¹, Anna Jang, ¹, Jessica Carmon, MD¹, Disha Kumar, MD¹, Frederick Peng, MD¹, Scott Larson, MD, PhD^2
1Baylor College of Medicine, Houston, TX; ²Michael E. DeBakey VA Medical Center, Houston, TX

Introduction: Presumed inadequate bowel prep (PIBP) is a recognized barrier to high quality colonoscopies, leading to cancellations and delays in colonoscopy completion. Adequate bowel prep is predicted by a pre-op questionnaire on prep completion, stool color/consistency, and NPO status. We present data after procurement of an over the scope irrigation system to reduce day-of-procedure cancellations for PIBP and complete high-quality colonoscopies.

Methods: We performed retrospective analysis of patients at the VA who were referred for outpatient colonoscopies and cancelled the day-of-procedure due to PIBP and prospective analysis on colonoscopies that would have otherwise been cancelled for PIBP having the over the scope irrigation device on standby. PIBP was assessed via pre-op questionnaire. Reason for cancellation, need of rescue device, BBPS, cecal intubation rate, and total colonoscopy times were collected.

Results: We reviewed 275 scheduled colonoscopies (Nov 2020-March 2021), of which 9% (n=39) were cancelled due to PIBP. Of these, 69% (n=27) were rescheduled and completed with an average time of 8.2 months from initial colonoscopy order and 4.1 months from day of cancellation. Of those cancelled, 30.8% (n=12) have not had a repeat colonoscopy within the VA at the time of data review (Nov 2022). In the retrospective group, 25.9% had tubular adenomas, 33.3% had advanced adenomas, and 3.7% had colorectal cancer (CRC). In the prospective group (Oct 2022-March 2023) 50 patients met inclusion criteria. Of these, 70% (n=35) were not NPO, 24% (n=12) had solid or colored stool, and 6% (n=3) did not complete prep. 62% (n=31) of these patients were adequately prepped without the need for the over the scope device, 20% (n=10) improved to adequate with the device, and 18% (n=9) remained inadequate. In the prospective group 36% had tubular adenomas, 24% had advanced adenomas, 2% had CRC, and 14% were unable to be completed. Total colonoscopy times was not significantly different between groups.

Discussion: One in ten colonoscopies were cancelled at our institution due to PIBP. Our study found that 82% of the PIBP could be completed the same day. Most patients had adequate prep without the need of the rescue device indicating fallacy in the pre-op questionnaire for bowel prep adequacy. These findings have important implications for health care systems striving to reach 80% colon cancer screening rates, as well as safety-net populations with growing colonoscopy backlogs.


Disclosures:


Lauren L. Comer, MD¹, Prisca Pungwe, MD¹, Anna Jang, ¹, Jessica Carmon, MD¹, Disha Kumar, MD¹, Frederick Peng, MD¹, Scott Larson, MD, PhD². P4055 - Same Day Cancellations for Presumed Inadequate Bowel Preparation: A Quality Assessment and Initiative, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.