Advertisement

Digestive Diseases and Sciences

, Volume 58, Issue 7, pp 1849–1855 | Cite as

Impact of an Incomplete Colonoscopy Referral Program on Recommendations After Incomplete Colonoscopy

  • Andrew J. Gawron
  • Annapoorani Veerappan
  • Sean T. McCarthy
  • Vineel Kankanala
  • Rajesh N. Keswani
Original Article

Abstract

Background

There are limited data on recommendations and adherence to complete colon evaluation (CCE) after incomplete colonoscopy (IC).

Aims

Our objectives were to (1) identify recommendations and adherence to recommendations after IC, (2) determine the diagnostic yield of CCE after IC, and (3) determine the effect of an IC referral program on recommendations for CCE.

Methods

We conducted a retrospective review of IC procedures at a teaching hospital over two time periods (January 1 to May 1 2004 and July 1 to November 1 2010). A referral process for repeat colonoscopy after IC was instituted in April 2009. Outcomes included (1) recommendations (2) adherence, and (3) yield of CCE after IC.

Results

A total of 222 patients underwent at least one IC (overall rate of 2.5 %). In 120 patients (54.1 %), CCE was recommended within 1 year; the rate did not change from 2004 to 2010. Patients with IC due to poor preparation were more likely to have specific CCE recommendations (85.5 vs. 72.2 %, P = 0.03) and recommendations of endoscopic follow-up (76.3 vs. 10.4 %, P < 0.0001) than those with IC due to difficult anatomy. When IC was due to difficult colonoscopy, there was increase in endoscopic follow-up recommended (16.3 vs. 2.8 %, P = 0.01) in 2010 compared to 2004. Adherence to recommendations was similar regardless of modality recommended, inpatient/outpatient status, polyps on initial exam, or extent of initial exam. Polyp detection rate was greater utilizing colonoscopy than barium enema (34.3 vs. 3.6 %, P < 0.0001).

Conclusions

There is a lack of consensus in management strategies for patients after IC. Implementation of a referral program has had minimal impact on provider recommendations.

Keywords

Colonoscopy Bowel preparation Screening Surveillance Colorectal cancer 

Abbreviations

CCE

Complete colon evaluation

CRC

Colorectal cancer

IC

Incomplete colonoscopy

Notes

Acknowledgments

Dr. Gawron is a National Research Service Award postdoctoral fellow at the Center for Healthcare studies under an institutional award from the Agency for Healthcare Research and Quality, T-32 HS 000078 (PI: Jane L. Holl, MD MPH). This work was also partially supported by a Grant (UL1RR025741) from the National Center for Research Resources at NIH.

Conflict of interest

None.

References

  1. 1.
    Levin B, Lieberman D, McFarland B, Andrews KS, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–1595.PubMedCrossRefGoogle Scholar
  2. 2.
    Winawer S, Fletcher R, Rex D, Bond J, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology. 2003;124:544–560.PubMedCrossRefGoogle Scholar
  3. 3.
    Rex DK, Petrini JL, Baron TH, Chak A, et al. Quality indicators for colonoscopy. Am J Gastroenterol. 2006;101:873–885.PubMedGoogle Scholar
  4. 4.
    Shah H, Paszat LF, Saskin R, Stukel T, et al. Factors associated with incomplete colonoscopy: a population-based study. Gastroenterology. 2007;132:2297–2303.PubMedCrossRefGoogle Scholar
  5. 5.
    Seeff LC, Richards TB, Shapiro J, Nadel MR, et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC’s survey of endoscopic capacity. Gastroenterology. 2004;127:1670–1677.PubMedCrossRefGoogle Scholar
  6. 6.
    Neerincx M, Mulder CJJ, Bartelsman JFWM, Loffeld RJ, et al. Colonic work-up after incomplete colonoscopy: significant new findings during follow-up. Endoscopy. 2010;42:730–735.PubMedCrossRefGoogle Scholar
  7. 7.
    Morini S, Zullo A, Hassan C, Lorenzetti R, et al. Endoscopic management of failed colonoscopy in clinical practice: to change endoscopist, instrument, or both? Int J Colorectal Dis. 2011;26:103–108.PubMedCrossRefGoogle Scholar
  8. 8.
    Hanson ME, Pickhardt PJ, Kim DH, Pfau PR. Anatomic factors predictive of incomplete colonoscopy based on findings at CT colonography. Am J Roentgenol. 2007;189:774–779.CrossRefGoogle Scholar
  9. 9.
    Rex DK, Chen SC, Overhiser AJ. Colonoscopy technique in consecutive patients referred for prior incomplete colonoscopy. Clin Gastroenterol Hepatol. 2007;5:879–883.PubMedCrossRefGoogle Scholar
  10. 10.
    Hassan C, Zullo A, Stagnitti A, Spagnuolo A, et al. CT colonography with reduced bowel preparation after incomplete colonoscopy in the elderly. Eur Radiol. 2008;18:1385–1395.PubMedCrossRefGoogle Scholar
  11. 11.
    Yucel C, Lev-Toaff AS, Moussa N, Durrani H. CT colonography for incomplete or contraindicated optical colonoscopy in older patients. Am J Roentgenol. 2008;190:145–150.CrossRefGoogle Scholar
  12. 12.
    Bisseling TM, Dekker HM, Cools B, Nagengast FM. CT colonography to visualise the whole colon can be complementary to incomplete colonoscopy. Neth J Med. 2006;64:389–390.PubMedGoogle Scholar
  13. 13.
    Triantafyllou K, Tsibouris P, Kalantzis C, Papaxoinis K, et al. PillCam Colon capsule endoscopy does not always complement incomplete colonoscopy. Gastrointest Endosc. 2009;69:572–576.PubMedCrossRefGoogle Scholar
  14. 14.
    Kao KT, Tam M, Sekhon H, Wijeratne R, et al. Should barium enema be the next step following an incomplete colonoscopy? Int J Colorectal Dis. 2010;25:1353–1357.PubMedCrossRefGoogle Scholar
  15. 15.
    Kaltenbach T, Soetikno R, Friedland S. Use of a double balloon enteroscope facilitates caecal intubation after incomplete colonoscopy with a standard colonoscope. Dig Liver Dis. 2006;38:921–925.PubMedCrossRefGoogle Scholar
  16. 16.
    Pasha SF, Harrison ME, Das A, Corrado CM, et al. Utility of double-balloon colonoscopy for completion of colon examination after incomplete colonoscopy with conventional colonoscope. Gastrointest Endosc. 2007;65:848–853.PubMedCrossRefGoogle Scholar
  17. 17.
    Moreels TG, Macken EJ, Roth B, Outryve MJV, et al. Cecal intubation rate with the double-balloon endoscope after incomplete conventional colonoscopy: a study in 45 patients. J Gastroenterol Hepatol. 2010;25:80–83.PubMedCrossRefGoogle Scholar
  18. 18.
    Keswani RN. Single-balloon colonoscopy versus repeat standard colonoscopy for previous incomplete colonoscopy: a randomized, controlled trial. Gastrointest Endosc. 2011;73:507–512.PubMedCrossRefGoogle Scholar
  19. 19.
    Schembre DB, Ross AS, Gluck MN, Brandabur JJ, et al. Spiral overtube-assisted colonoscopy after incomplete colonoscopy in the redundant colon. Gastrointest Endosc. 2011;73:515–519.PubMedCrossRefGoogle Scholar
  20. 20.
    Suzuki T, Matsushima M, Tsukune Y, Fujisawa M, et al. Double-balloon endoscopy versus magnet-imaging enhanced colonoscopy for difficult colonoscopies, a randomized study. Endoscopy. 2012;44:38–42.PubMedCrossRefGoogle Scholar
  21. 21.
    Hotta K, Katsuki S, Ohata K, Abe T, et al. A multicenter, prospective trial of total colonoscopy using a short double-balloon endoscope in patients with previous incomplete colonoscopy. Gastrointest Endosc. 2012. doi: 10.1016/j.gie.2011.11.020.PubMedGoogle Scholar
  22. 22.
    Dzeletovic I, Harrison ME, Pasha SF, Crowell MD, et al. Comparison of single- versus double-balloon assisted-colonoscopy for colon examination after previous incomplete standard colonoscopy. Dig Dis Sci. 2012. doi: 10.1007/s10620-012-2227-z.PubMedGoogle Scholar
  23. 23.
    Dafnis G, Granath F, Ekbom A, Blomqvist P, et al. Patient factors influencing the completion rate in colonoscopy. Dig Dis Sci. 2005;37:113–118.Google Scholar
  24. 24.
    Keswani RN. Successful colonoscopy in patients referred for prior incomplete colonoscopy does not require more time but often requires use of a different endoscope. Gastrointest Endosc. 2012; Dig Dis Week (accepted abstract).Google Scholar
  25. 25.
    Yong E, Zenkova O, Saibil F, Cohen LB, Rhodes K, Rabeneck L. Efficiency of an endoscopy suite in a teaching hospital: delays, prolonged procedures, and hospital waiting times. Gastrointest Endosc. 2006;64:760–764.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Andrew J. Gawron
    • 1
    • 2
  • Annapoorani Veerappan
    • 1
  • Sean T. McCarthy
    • 1
  • Vineel Kankanala
    • 1
  • Rajesh N. Keswani
    • 1
  1. 1.Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Center for Healthcare Studies, Feinberg School of MedicineNorthwestern UniversityChicagoUSA

Personalised recommendations