Bowel Preparation Understanding Major Barrier to Completion of Colonoscopy

Reasons for missed colonoscopies (Adapted from Castillo M. Poster presented at: ACG 2019 Annual Scientific Meeting; October 2019; San Antonio, TX)

San Antonio - A variety of factors may lead to patients cancelling or being unable to complete colonoscopies. In fact, a new study shows that difficulty understanding or tolerating bowel preparation may cause almost 40% of colonoscopy cancellations.

Researchers-led by Michael Castillo, MD, of the Cleveland Clinic Foundation, Miami, Florida-presented results of the study on October 27 at the 2019 Annual Scientific Meeting of the American College of Gastroenterology in San Antonio, Texas. 

The retrospective study enrolled patients scheduled for screening or diagnostic colonoscopy at Cleveland Clinic Florida from January to June 2018. Researchers compared individual and systemic factors between a random group of 200 patients who completed their colonoscopy (control group) and those who did not.

Of the 4 499 colonoscopies scheduled over the 6-month study period, 8.2% were missed or cancelled and 2.6% were incomplete.

Patients of black race (odds ratio [OR]=2.1; P=.01) and patients with international addresses (OR=2.34; P=.04) were twice as likely to have incomplete colonoscopies vs control group participants.

Decreased risk for missed colonoscopies was seen in:

• White patients (OR=0.56; P=.001)

• Patients with a history of polyps (OR=0.52; P<.001)

• Patients with previous colonoscopy (OR=0.32; P<.0001)

• Patients with a diagnosis of irritable bowel disease (OR=0.21; P=.001)

• Patients who were married (OR=0.52; P=.001)

“Many patients appeared to have difficulty understanding bowel preparation instructions,” according to the researchers. In fact, difficulty understanding or tolerating these preparations resulted in 39.2% of cancellations. Another common reason given for cancellations was illness (22.0%). In addition, Monday was the most common day for appointment cancellation (12.6%).

“…In fact, difficulty understanding or tolerating these [bowel] preparations resulted in 39.2% of cancellations.

According to Castillo and colleagues, cancelled colonoscopy appointments can have a great effect on healthcare costs, provider workflow, and delays in cancer diagnosis. Future efforts should be made to focus on improving bowel preparation education, which could lead to improvement in health care utilization.