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Achieving a Complete Colonic Evaluation in Patients With Incomplete Colonoscopy Is Worth the Effort

Ridolfi, Timothy J. M.D.; Valente, Michael A. D.O.; Church, James M. M.D.

Diseases of the Colon & Rectum: March 2014 - Volume 57 - Issue 3 - p 383–387
doi: 10.1097/DCR.0000000000000072
Original Contributions: Endoscopy

BACKGROUND: Patients with an incomplete colonoscopy are potentially at risk for missed lesions.

OBJECTIVE: The purpose of this work was to identify the percentage of patients completing colonic evaluation after incomplete colonoscopy, the manner in which the evaluation was completed, and the incidence of significant pathology.

DESIGN: This was a retrospective analysis of prospectively collected data.

SETTINGS: The study was conducted in an outpatient colonoscopy clinic in the colorectal surgery department of a tertiary referral center.

PATIENTS: Patients included those undergoing incomplete colonoscopy from a database of 25,645 colonoscopies performed from 1982 to 2009.

INTERVENTIONS: Procedures aimed at completing colorectal evaluation were included in the study.

MAIN OUTCOME MEASURES: Reason for incompletion, secondary study, its success, and findings were measured.

RESULTS: A total of 242 patients with incomplete colonoscopies were identified; 166 (69%) were women. The average age of patients was 59 years. Most frequent causes for incomplete colonoscopy were inadequate preparation (34%), pain (30%), and tortuosity (20%). The scope could not pass the splenic flexure in 165 patients (71%). A total of 218 patients (90%) were offered completion studies, and 179 patients (82%) complied. Seventy-three of 82 patients who had a surveillance colonoscopy had a follow-up (89%), compared with 72 (87%) of 83 with symptoms and 40 (74%) of 54 who had a screening. Barium enema (BE) was performed in 74 (41%), repeat colonoscopy in 71 (40%), CT colonography in 17 (9%), and colonoscopy under general anesthesia in 9 patients (5%). Resection with intraoperative/perioperative colonoscopy was required in 8 patients (4%). Repeat colonoscopy found 32 lesions (24 tubular adenomas, 4 tubulovillous adenomas, and 4 sessile serrated polyps) in 17 patients (24%). Radiology demonstrated new abnormalities in 11 (12%) of 91 patients, prompting 7 colonoscopies. In 3 patients, colonoscopy showed an inverted appendix, a tubulovillous adenoma, and a sigmoid stricture. Overall, clinically significant lesions were found in 19 patients (10%).

LIMITATIONS: This study was limited by an incomplete colonoscopy subjectively determined at the time of colonoscopy, as well as by a lack of comparison group.

CONCLUSIONS: Complete colonic evaluation in patients with an incomplete colonoscopy is important. Repeat colonoscopy may be the most efficient way to achieve this.

Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio

Financial Disclosure: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Phoenix, AZ, April 27 to May 1, 2013.

Correspondence: James M. Church, M.D., Desk A 30, 9500 Euclid Ave, Cleveland, OH, 44195. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons