Evaluating the practice of canceling colonoscopies for presumed inadequate bowel preparation

ABSTRACT
Background and Aims: There are scant data describing the practice of canceling colonoscopies before colonoscope insertion for presumed inadequate bowel preparation (PIBP). We sought to better understand the ramifications of such cancellations and to characterize the nationwide practice of cancellations for PIBP.

Methods: We determined the frequency of colonoscopies canceled for PIBP at our institution, assessing practice variation and whether patients who were canceled for PIBP completed colonoscopy or fecal immunohistochemical testing (FIT) within 6 months. We also surveyed gastroenterology program directors to determine whether canceling colonoscopies for PIBP is commonly permitted and if such cancellations are included in calculations of bowel preparation adequacy rates.

Results: Three percent of patients were canceled for PIBP at our institution, with significant provider practice variability in cancellation rates. Only 67% of patients whose cases were canceled for PIBP completed colonoscopy or FIT within 6 months. The ability of an endoscopist to cancel a colonoscopy for PIBP was reported by 97% of survey respondents. Such cases are frequently not included in calculations of bowel preparation adequacy rates.

Conclusions: The ability to cancel colonoscopies for PIBP is near-ubiquitous, but such cases are not uniformly included in calculations of bowel preparation adequacy rates. Variation in provider practice, and resulting impact on patient care, suggests a need for standardized protocols. Colonoscopies canceled for PIBP should be included in calculations of bowel preparation adequacy rates.