IDDF2023-ABS-0156 Poor tolerance of bowel preparation for index colonoscopy decreases surveillance rate in high-risk adenoma removal patients

Background

While US guidelines and Asia-Pacific consensus recommend triennial surveillance colonoscopy in this high-risk population, the surveillance rate is suboptimal and barriers to surveillance colonoscopy should be investigated. Patient tolerance of bowel preparation (BP) affects the willingness to repeat colonoscopy. However, it is unknown whether poor tolerance of BP for index colonoscopy actually decreases surveillance colonoscopy compliance. This prospective study aimed to investigate the surveillance rate in patients with the removal of high-risk adenomas and the predictors associated with compliance in surveillance colonoscopy, focusing on the patient tolerance of BP for index colonoscopy.

Methods

A prospective cohort study was conducted of 1157 consecutive outpatients receiving a colonoscopy, and included patients with the removal of high-risk adenomas. The surveillance rate was evaluated 3 years after the removal of high-risk adenomas. Tolerance of BP was rated on a 5-point scale before receiving an index colonoscopy and poor tolerance was defined as ≤ 2. The patients who did not receive surveillance colonoscopy were called to inquire about the reasons. Factors associated with surveillance colonoscopy compliance were determined by regression analysis.

Results

A total of 186 patients with high-risk adenomas were included, and 62 patients (33%) did not receive surveillance colonoscopy in 3 years (IDDF2023-ABS-0156 Figure 1). Poor tolerance of BP was found in 36 patients (19%). The surveillance rate was significantly lower in patients with poor BP tolerance than those with good tolerance (47% vs 72%, P < 0.01), and decreased with poorer tolerance on index colonoscopy (P for trend < 0.05) (IDDF2023-ABS-0156 Table 1). In multivariate analysis, poor tolerance (OR=2.45, 95% CI 1.11-5.41) and no gastroenterology visitation after index colonoscopy (OR=4.63; 95% CI 1.60-13.4) were independent risk factors for non-compliance in surveillance colonoscopy (IDDF2023-ABS-0156 Table 2). The main reason for non-compliance was an unwillingness to repeat BP for surveillance colonoscopy (N =17/62, 27%) (IDDF2023-ABS-0156 Table 3).

Conclusions

Our findings highlight the need for improvement of the surveillance colonoscopy rate, especially for patients who had poor tolerance to BP on index colonoscopy and no gastroenterology visit. Providing a well-tolerated BP regimen may lead to an increase in surveillance colonoscopy compliance.