Assessment of Suboptimal Bowel Preparation is Highly Variable among Physicians in The Same Practice and Not Associated with Their Adenoma Detection Rates

Abstract

Introduction: Suboptimal colonic preparation adversely impacts the adenoma detection rate (ADR) and increases healthcare costs. Though a low threshold for categorizing the preparation as inadequate increases repeat colonoscopies, such fastidiousness could result in a higher quality colonoscopy. Our objectives were: 1) To examine the variability among colonoscopists in their bowel prep ratings and 2) To assess the correlation between suboptimal prep rate (SPR) and ADR. Methods: We conducted a retrospective analysis of all outpatient colonoscopies performed from 2013-2015 at the Minneapolis Veterans Affairs Medical Center. Data were coded by indication for colonoscopy and bowel prep grading (Aronchick Scale). Suboptimal bowel prep was defined as the sum of fair and poor prep grades. Suboptimal prep rates (SPR) per year were calculated for each endoscopist. A random sample of 50 screening colonoscopies/year with adequate prep was used to calculate each endoscopist’s ADR Results: There were 7125 colonoscopies performed by 10 endoscopists during the study period. Results showed large variability of SPR amongst endoscopists, ranging from 5% to 38% (p<0.001, chi-square). Logistic mixed model regression revealed that SPR (for each provider) was not a significant predictor of adenoma detection (OR=1.012 [95% CI: 0. 99-1. 03]; p=0.29). Discussion: The study demonstrates consistent major differences between individual endoscopists regarding the frequency of grading colonic preps as suboptimal. Based on ADR, strict interpretation of the adequacy of the prep did not translate into a more effective colonoscopy. Thus, training about what constitutes an adequate prep could reduce unnecessary repeat colonoscopies.