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News

Bowel cleansing influences recommendations in average-risk patients withnormal colonoscopy

February's American Journal of Gastroenterology evaluates the impact of bowel cleansing on follow-up recommendations in average-risk patients with a normal colonoscopy.

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Repeat colonoscopy in 10 years after a normal screening colonoscopy is recommended in an average-risk patient, and it has been proposed by American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), and American Society for Gastrointestinal Endoscopy (ASGE) as a quality measure.

However, there are little quantitative data about adherence to this recommendation or factors that may improve adherence. Our study quantifies adherence to this recommendation and the impact of suboptimal bowel preparation on adherence.

Dr Stacy Menees and colleagues from Michigan, USA performed a retrospective database study, of endoscopy reports of average-risk individuals ≥50 years old with a normal screening colonoscopy were reviewed.

Quality of colon cleansing was recorded using the Aronchick scale as excellent, good, fair, or poor.

The researchers main outcome measurements were quality of bowel preparation and recommendation for timing of repeat colonoscopy.

75% of fair bowel preparations were assigned recommendations inconsistent with guidelines
American Journal of Gastroenterology

Recommendations were considered consistent with guidelines if 10-year follow-up was documented after excellent, good, or fair prep or if ≤1-year follow-up was recommended after poor prep.

Among 1,387 eligible patients, the team found that recommendations for follow-up colonoscopy inconsistent with guidelines were seen in 24% of subjects.

By bowel preparation quality, 15% of excellent/good, 75% of fair, and 32% of poor bowel preparations were assigned recommendations inconsistent with guidelines.

The research team found that patients with fair were more likely to have recommendations inconsistent with guidelines compared with patients with excellent/good preps.

Dr Menees' team concludes, "Recommendations inconsistent with guidelines for 10-year intervals after a normal colonoscopy occurred in >20% of patients."

"Minimizing “fair” bowel preparations may be a helpful intervention to improve adherence to these recommendations."

Am J Gastroenterol 2014; 109: 148–154
21 February 2014

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