Matthew J. Sullivan, DO1, Abdul Aleem, MD1, Rajesh Essrani, MD2, Patrick Hickey, DO3, Eric Nellis, MD1, Robert Andrews, MD1, Hiral N. Shah, MD4, Shashin Shah, MD4
1Lehigh Valley Health Network, Allentown, PA; 2Geisinger Medical Center, Danville, PA; 3LVHN, Macungie, PA; 4Eastern Pennsylvania Gastroenterology and Liver Specialists, Allentown, PA
Introduction: Open access colonoscopy (OAC) is the process by which a patient is referred directly for colonoscopy without a pre-procedure consultative office visit. This process has been shown to decrease wait time for screening colonoscopies which can subsequently improve adherence rates. However, identifying patients at increased risk for complications or low quality colonoscopy who would benefit from a pre-procedure office visit can be difficult and no specific society guidelines exist.
Methods: At our fellow-run gastroenterology clinic, we retrospectively evaluated all patients who underwent screening colonoscopy during the 2016 to 2018 academic years with the aim of identifying any difference in colonoscopy quality parameters between patients deemed eligible or ineligible for OAC. The charts of all patients at average risk for colorectal cancer who were scheduled for screening colonoscopy with a fellow during the study period were reviewed. For this study, all patients were seen at an office visit prior to their procedure. We also individually evaluated our exclusion criteria for OAC.
Results: 45 of 68 (66.2%) patients would have been eligible for OAC based on our current exclusion criteria. We examined 3 quality indicators for screening colonoscopy and full results are available in Table 1. Overall, there were no significant differences between the groups for bowel prep adequacy, cecal intubation rate, or adenoma detection rate (ADR). However, prep adequacy approached significance (P=0.076). Patients taking an anticoagulant, those with NYHA class III or IV CHF, CKD4-5, or uncontrolled diabetes (A1c 8% or greater) were significantly more likely to have an inadequate bowel prep. Uncontrolled diabetes was our most frequent reason for ineligibility for OAC.
Discussion: Literature on OAC is robust, but pathways involving trainees and studies examining exclusion criteria are less prevalent. Our study demonstrated no significant differences in quality indicators for colonoscopy in patients ineligible for OAC, but did reveal significant differences in prep adequacy for certain medical conditions. Interestingly, the ADR for ineligible patients (27.3%) was higher than that for eligible patients (22.2%). Our results indicate that further investigation is required to identify patients who would benefit from a pre-colonoscopy office visit. Our exclusion criteria also require further examination to identify other potential risk factors or sub-groups at risk for low quality colonoscopy.
Citation: Matthew J. Sullivan, DO; Abdul Aleem, MD; Rajesh Essrani, MD; Patrick Hickey, DO; Eric Nellis, MD; Robert Andrews, MD; Hiral N. Shah, MD; Shashin Shah, MD. P1117 - CAN WE PREDICT LOW QUALITY COLONOSCOPY? ESTABLISHING OPEN ACCESS COLONOSCOPY AT A FELLOW-RUN GASTROENTEROLOGY CLINIC. Program No. P1117. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.