Next-day colonoscopy may improve adenoma detection after poor prep
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Scheduling a repeat colonoscopy the day after inadequate preparation may give a better chance for adequate prep and improve adenoma detection in a veteran population, according to research presented at the ACG Virtual Annual Scientific Meeting.
In her presentation, Erin Bouquet, MD, from Vanderbilt University Medical Center, said current guidelines suggest that repeat colonoscopy after poor preparation should be completed within 1 year.
“We asked whether within that recommended 1-year interval, is there an optimal interval at which a colonoscopy should be repeated,” she said. “Specifically, we asked ‘is next day repeat colonoscopy superior to repeat colonoscopy at a later date, in terms of either repeat prep adequacy or adenoma detection in repeat colonoscopy?’”
Researchers identified patients who underwent screening colonoscopies at a tertiary Veterans’ Affairs medical center but had inadequate bowel preparation using data from an electronic logbook. They excluded patients if the colonoscopy was performed for an indication other than colorectal cancer screening and in patients who died within 1 year of their initial colonoscopy.
Investigators collected information on inadequate preparation rate and timing of repeat colonoscopy and compared preparation adequacy, polyp number and presence of adenoma between groups of patients who underwent repeat colonoscopy the next day and those who completed their repeat colonoscopy within 1 year.
Of 534 total patients with inadequate preparation, 135 underwent colonoscopy the next day (25%), 206 did so within 1 year (39%), 51 in more than 1 year (10%) and 142 did not return to the center for another colonoscopy (26%).
Researchers found that adequate bowel preparation trended toward more likely in the next-day colonoscopy group compared with those who completed it within 1 year (OR = 1.58; 95% CI, 0.83-3.03). The likelihood of presence of adenoma also trended toward increased (OR = 1.44; 95% CI, 0.89-2.33).
In their analysis of patients who used a split-dose prep, investigators found a trend toward improved preparation (OR = 3.03; 95% CI, 0.64–14.31) and likelihood of adenoma detection (OR = 3.12; 95% CI, 1.43–6.81).
“As split preparation is now the gold standard, our subgroup analysis may more accurately represent today’s population,” Bouquet said. “However, further studies are needed to determine if next-day, repeat colonoscopy following inadequate bowel preparation improves quality and efficacy of colorectal cancer screening.”
Perspective
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Catherine Ly, DO
This study helps to validate what many gastroenterologists have been practicing for years. By scheduling a repeat colonoscopy, the day after an inadequate preparation, the patient is more likely to achieve a satisfactory preparation, which is an important part of adenoma detection, and less likely to be lost to follow-up.
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Bouquet E, et al. Abstract S0518. Presented at: The American College of Gastroenterology Annual Scientific Meeting (Virtual). Oct. 26-28, 2020.
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