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Open Access Colonoscopy for Colorectal Cancer Prevention: An Evaluation of Appropriateness and Quality

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Abstract

Background

Open access colonoscopy (OAC) has gained widespread acceptance and has the potential to increase colorectal cancer (CRC) screening. However, there is little data evaluating its appropriateness for CRC prevention.

Aims

The aim of this study is to evaluate the appropriateness of OAC in CRC screening and polyp surveillance by comparing to procedures ordered by gastroenterologists (NOAC). As secondary outcomes, we compared the quality of bowel preparation and adenoma detection rate (ADR) between OAC and NOAC.

Methods

It is retrospective single-center study. Inclusion criteria included patients > 50 years of age undergoing a colonoscopy for CRC screening and surveillance. Appropriateness was defined as those colonoscopies performed within 12 months of the recommended 2012 consensus guidelines. Secondary outcomes included the quality of bowel preparation and ADR.

Results

5211 colonoscopies met inclusion criteria, and 64.9% were OAC. Screening OAC was appropriately 91.6% and NOAC 92.9% of the time (p = 0.179). Surveillance NOAC were inappropriate in 26.4% of cases, and surveillance OAC was 32.6% (p = 0.008). Multivariate analysis demonstrated that OAC did not influence ADR (OR for NOAC 0.97; 95% CI 0.86–1.1; p = 0.644) or an adequate bowel preparation (OR for NOAC 1.11; 95% CI 0.91–1.36; p = 0.306).

Conclusion

OAC performed similarly to NOAC for screening indications, quality of bowel preparation, and ADR. However, more surveillance procedures were inappropriate in the OAC group although both groups had a high number of inappropriate indications. Although OAC can be efficiently performed for screening indications, measures to decrease inappropriate surveillance colonoscopies are needed.

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Acknowledgments

Dr. Molly Moor, Meaghan McMahon, Dr. Hong Liang.

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Authors and Affiliations

  1. Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, USA

    Nikhil Kapila, Harjinder Singh, Kiranmayee Kandragunta & Fernando J. Castro

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  1. Nikhil Kapila
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  2. Harjinder Singh
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  4. Fernando J. Castro
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Kapila, N., Singh, H., Kandragunta, K. et al. Open Access Colonoscopy for Colorectal Cancer Prevention: An Evaluation of Appropriateness and Quality. Dig Dis Sci 64, 2798–2805 (2019). https://doi.org/10.1007/s10620-019-05612-8

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  • DOI: https://doi.org/10.1007/s10620-019-05612-8

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