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Level 4, Technical Report.

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Introduction Unless the full colon is adequately visualised at colonoscopy there is a risk of missing signifi cant pathology including advanced neoplasia and colorectal cancer (CRC). Incomplete colonoscopy occurs in 10%, and while the reasons for failure are well described, overall outcomes of these patients are not. These patients may be subjected to a second investigation or left partially investigated. The aim of this study was to determine the eventual patient outcomes following their initial failed colonoscopy. Methods All incomplete colonoscopies (not reached caecum or ileum) performed between April 2005 and 2010 at the Royal Liverpool University Hospital were identifi ed via the endoscopy database. All were audited (100% uptake) using a standard proforma and entered onto an Access database for interrogation. Results Of the 8910 colonoscopies performed, 693 (58% Female; mean age 61 years) were incomplete (7.8%). Reasons included bowel prep (24.8%), discomfort (22.2%), obstruction (17.2%), looping (13.6%), diverticular (4.3%), adverse events (0.4%), other causes (3.2%) or unrecorded (16.9%). Despite the initial incomplete procedure, CRC were found in 9.7% and signifi cant polyps (>1 cm) in 5.9%. A second investigation was performed in 324 (47%) patients. The most common second investigations were repeat colonoscopy in 35.8% (mean time to test 59 days) followed by CT colonography (CTC) in 20.7% (time 20 days), CT abdomen (CTA) in 17.9% (time 4 days) and barium enema in 16.7% (time 48 days). At second investigation, new diagnoses CRC were made in 0.9% (CTC, CTA and colonoscopy diagnosed 2 each), signifi cant polyps in 0.9%, malignant extracolonic pathology in 1.7% and non-signifi cant extracolonic pathology in 3.8%. Overall yield for signifi cant pathology (cancer or large polyps) was 7% for repeat colonoscopy, 13.4% for CTC, 10.3% for CTA and 1.8% for barium enema. There were 343 (49.5%) patients who had no