32 (S0518). - Next-Day Screening Colonoscopy Following Inadequate Bowel Preparation May Improve Quality of Preparation and Adenoma Detection in a Veteran Population

Erin Bouquet, MD, Justin Tomal, MD, Yash Choksi, MD; Vanderbilt University Medical Center, Nashville, TN

Introduction: For screening colonoscopy, AGA guidelines recommend that if the cecum is reached but preparation is inadequate, colonoscopy should be repeated within one year. Our aims were to determine (1) the timing of return after inadequate colonoscopy preparation in a veteran population at our medical center and (2) whether next-day repeat colonoscopy was superior to repeat within a year.

Methods: This is a retrospective study evaluating screening colonoscopies with inadequate preparations from July 2011- July 2019 at tertiary care VA medical center. Cases were identified using an electronic log book of every colonoscopy performed at the medical center. Patient demographics and details of the colonoscopies were obtained from the electronic health record. Cases were excluded if performed for an indication other than colorectal cancer screening and in patients who died within one year of their initial colonoscopy. Inadequate preparation rate and timing of repeat colonoscopy was determined. Preparation adequacy, polyp number, and presence of adenoma was compared between those undergoing next-day colonoscopy and those undergoing repeat within one year. Subgroup analyses were performed on cases after July 2016, when split preparation was implemented.

Results: 534 patients were identified with inadequate preparation. Patient demographics and procedural details are summarized in Table 1. Of these, 135 came back for repeat colonoscopy the next day (25%), 206 within 1 year (39%), 51 in greater than 1 year (10%), and 142 did not return to this VA for another colonoscopy (26%). Adequate bowel preparation trended towards more likely in next-day repeat colonoscopy when compared to those undergoing repeat within a year (OR 1.58 (95% CI: 0.83–3.03)). Moreover, in the next-day group, likelihood of presence of adenoma trended towards increased (OR 1.44 (95% CI: 0.89–2.33), Table 2). In patients using split preparation, likelihood of adequate bowel preparation also trended towards significance (OR: 3.03 (95% CI: 0.64–14.31)), and likelihood of adenoma detection was significantly increased (OR 3.12 (95% CI: 1.43–6.81), Table 3).

Discussion: In a veteran population, next-day repeat colonoscopy following inadequate bowel preparation may result in increased likelihood of adequate preparation and improved adenoma detection, especially with split preparation.


Clinical Characteristics of Veterans with Inadequate Bowel Preparation


Next-Day versus Within 1 Year Repeat Colonoscopy: Preparation Adequacy (top) and Polyp/Adenoma Detection (bottom)


Next-Day versus Within 1 Year Repeat Colonoscopy in those with Split Bowel Preparation: Preparation Adequacy (top) and Polyp/Adenoma Detection (bottom)

Disclosures:
Erin Bouquet indicated no relevant financial relationships.
Justin Tomal indicated no relevant financial relationships.
Yash Choksi indicated no relevant financial relationships.