Endoscopists' Written Communication After Surveillance Colonoscopy in Older Adults Is Often Unclear

BACKGROUND AND AIMS: Current guidelines recommend that the decision to pursue surveillance colonoscopy in older adults with polyps be individualized, yet how these recommendations are communicated has not been characterized. We aimed to evaluate the effectiveness of endoscopist recommendations after colonoscopy in communicating the need for future surveillance in older adults. METHODS: We performed a single-center, retrospective chart review of adults age > 75 years who underwent colonoscopy for polyp surveillance or screening during which polyps were detected. We performed content analysis of the recommendations from both colonoscopy reports and post-pathology follow-up letters. Recommendations were classified as optimal or less optimal based on whether they were clear, contained a rationale, and maintained consistency between the report and follow-up letter. RESULTS: Between 2012 and 2019, there were 1428 colonoscopies performed by 17 endoscopists, of which 874 (61%) were optimal and 554 (39%) were less optimal. Among the less optimal recommendations, 76 (14%) lacked a recommendation, 233 (42%) were unclear, and 409 (74%) lacked a rationale. Among the 954 post-pathology follow-up letters, 80 (8%) were inconsistent with the original colonoscopy report recommendation, of which 30 (38%) resulted in a change in management. The frequency of less optimal recommendations ranged from 0% to 50% by endoscopist. CONCLUSION: Following colonoscopy in older adults, we found that roughly one-third of the reports were less than optimal, and there was sizable variation in individual endoscopist performance. Discrepancies between colonoscopy reports and patient follow-up letters could be minimized by avoiding providing recommendations on future colonoscopy before pathologic interpretation.