Post written by Brian C. Jacobson, MD, MPH, from the Boston Medical Center and the Boston University School of Medicine, Boston, Massachusetts, USA.

We sought to better understand how often endoscopists cancel a colonoscopy during the triage phase (ie, before colonoscope insertion) because of concern that the patient’s bowel preparation will be inadequate.

An important colonoscopy quality measure per the U.S. Multi-Society Task Force on Colorectal Cancer is the frequency of inadequate bowel preparations. However, it is not clear if providers include cases cancelled during the triage phase when making this calculation. Further, we were not sure how often such cancellations occur at our facility, nor if such a practice is allowed at other endoscopy units.

We now know that many endoscopy units have rules in place that allow for colonoscopy cancellations prior to colonoscope insertion. Moreover, many practices that allow for such cancellations do not include these cases in their calculation of inadequate bowel preparation. Because of this, we think endoscopy unit leaders should consider standardizing protocols to either require colonoscope insertion or to at least include cases cancelled prior to colonoscope scope insertion in calculations of bowel preparation inadequacy rates.

An important limitation of our study is that our nationwide survey was designed to determine how commonly endoscopy units permit triage-phase cancellations, but not to determine how frequently cases are actually cancelled. We therefore do not know if our unit’s 3% rate of triage-phase cancellations is generalizable.

Figure 1. Flow of ambulatory patients arriving at our endoscopy unit for colonoscopy. FIT, Fecal immunohistochemical test.

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