Outcomes following an initial unsuccessful colonoscopy: a 5-year complete audit of teaching hospital colonoscopy practice

Abstract

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

Endoscopy audit over 10 years in a community hospital in Egypt

“…[27][28][29] Inadequate bowel preparation was the most common reason for incomplete colonoscopy, accounting for nearly 25% of failed colonoscopies, in a 5-year complete audit of colonoscopy practice in a teaching hospital in the United Kingdom. 30 Never the less, crude colonoscopy completion rates did increase significantly from 66% in 2004-2008 to 79% in 2009-2013 and adjusted completion rates from 80% in 2004-2008 to 95% in 2009-2013. Published colonoscopycompletion rates vary substantially ranging from 76% to 99%.…”

Modelling characteristics of inadequate bowel preparations for colonoscopy

“…It is estimated that 10%‐20% of colonoscopies performed are incomplete or inadequate examinations with either the inability to intubate the caecum and/or inability to adequately inspect the mucosa . The most common cause of an incomplete colonoscopy is poor bowel preparation (BP) …”

“…4 The most common cause of an incomplete colonoscopy is poor bowel preparation (BP). 5 Poor BP precludes the ability to properly visualise the colonic mucosa, thereby leading to failed detection of a neoplasm. Chokshi and colleagues found that among those patients who underwent repeat colonoscopy after an initial colonoscopy with inadequate BP and no polyps seen, 31% had at least one adenoma detected on their repeat study.…”

Is whole-colon investigation by colonoscopy, computerised tomography colonography or barium enema necessary for all patients with colorectal cancer symptoms, and for which patients would flexible sigmoidoscopy suffice? A retrospective cohort study

“…10,11 The bowel preparation required for colonoscopy is often the part of this procedure that patients find most difficult, 12 and failure to complete it results in loss of procedural accuracy. 10,13,14 There is also a small miss rate of colonoscopy for colorectal neoplasia, as demonstrated by tandem colonoscopy studies. 15 …”