Factors Causing Incomplete Colonoscopy Reported by the Endoscopist

Colonoscopy is a primary diagnostic method for colorectal cancer screening. Ensuring completeness is critical for its effectiveness. The aim of this study is to explores patient and procedure-related contributors to incomplete colonoscopy in a Danish high volume endoscopy unit. A population-based register study was conducted, using data from electronic health records from a Danish hospital was analyzed, covering all colonoscopies performed between July 2015 and August 2019. The primary outcome assessed was the completeness of the index colonoscopy, with incomplete cases further classified based on the causes for incompleteness that were assessed and documented in real-time by the endoscopist. Data also included patient demographics and comorbidities, and profession of the endoscopist. Among 33,128 colonoscopies, prevalence of incomplete colonoscopies was 6.55%, with inadequate bowel preparation as the leading cause (60.3%). Men were more prone to inadequate bowel preparation, while procedural pain, non-passability, and stenosis were associated with women. Physician endoscopists exhibited higher incomplete colonoscopy rates compared to nurse endoscopists, and patients with higher comorbidity scores were more likely to have incomplete colonoscopy. This study highlights the prevalence of incomplete colonoscopy and recognizes modifiable risk factors like inadequate bowel preparation and procedural pain. Findings underscore the need for personalized interventions, stressing ongoing endoscopist education and targeted strategies to improve colonoscopy effectiveness.