Recommendations for follow-up interval after colonoscopy with inadequate bowel preparation in a national colonoscopy quality registry.

Abstract Background and Aims Endoscopist recommendations around repeating colonoscopy after inadequate bowel cleanliness have not been fully described. Our aim was to evaluate the timing of recommendations for repeat colonoscopy after inadequate bowel preparation using a large, national colonoscopy registry. Methods We performed a cross-sectional analysis of all outpatient screening and surveillance colonoscopies among adults age 50 to 75 reported in the GI Quality Improvement Consortium (GIQuIC) from 2011 to 2018. The primary outcome was a recommendation to repeat colonoscopy within 1 year. Secondary outcomes included recommendations based on indication of colonoscopy and colonoscopy findings, and predictors of a recommendation to follow-up within 1 year. Results There were 260,314 colonoscopies with inadequate bowel preparation performed at 672 different sites by 4,001 endoscopists. Of these, 31.9% contained a recommendation for follow-up within 1 year. This did not differ meaningfully by examination indication. The severity of colonoscopy findings influenced the recommendations for follow-up (within 1 year in 84.0% of cases with adenocarcinoma, 51.8% with any advanced lesion, and 23.2% with 1-2 small adenomas). Younger age, more severe pathology, location in the Northeast, and performance by an endoscopist with an adenoma detection rate ≥25% were associated with recommendations for follow-up within 1 year. Conclusions A minority of colonoscopies with inadequate bowel preparation are recommended to be repeated within 1 year, which may have implications for potential missed lesions. Further understanding of reasons driving recommendations is an important next step to improving guideline-concordant colonoscopy practice.