Endoscopist’s written recommendation for a 1-year repeat colonoscopy when inadequate bowel preparation: an easy, cheap and highly effective measure to improve adherence

Aims When bowel preparation is inadequate, international guidelines recommend repeating the colonoscopy within one year to avoid missing clinically relevant lesions. One key reason for inappropriate surveillance is the lack of proper recommendations. This study aimed to evaluate the association between endoscopist-written recommendations and patient adherence to repeat colonoscopy.

Methods A single-centre ambispective cohort study was conducted. The study included a retrospective cohort with no written recommendations for repeat colonoscopy and a prospective cohort with written recommendations to repeat the colonoscopy within one year. Both groups received oral instructions on the appropriate surveillance interval. Inadequate bowel preparation was defined as a Boston Bowel Preparation Scale score of less than 2 points in any segment. The primary outcome was patient adherence to repeat colonoscopy within one year. Secondary outcomes included identifying predictors for the inclusion of the written recommendation in the report and colonoscopy findings [1] [2] [3] [4] [5] [6].

Results A total of 493 patients with inadequate bowel preparation were included, with 309 in the retrospective cohort and 184 in the prospective cohort. Patients who received written recommendations showed a 91% increase in adherence to repeat colonoscopy within one year compared to those without recommendations (53.8% vs. 28.1%, p<0.001). The majority of repeat colonoscopies achieved adequate bowel preparation (79.8%; 79/99). Among these, the adenoma detection rate was 34.2% (27/79), and cancer was detected in 1.27% (1/79) of the repeat colonoscopies.

Conclusions Providing a written recommendation after inadequate bowel cleansing is an easily applicable and highly effective measure to improve adherence to repeat colonoscopy within one year.

Publication History

Article published online:
27 March 2025

• References

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