S612 Poor Adherence to Repeat Quality Colonoscopy After Inadequate Bowel Preparation: Analysis From GIQuIC Registry

Introduction: Adequate bowel preparation (ABP) is essential to optimize quality colonoscopy-related outcomes. The USMSTF 2025 guideline recommends rates >90% for ABP. Inadequate bowel preps (IBPs) important implications including: direct/indirect related costs, delayed or missed diagnosis, loss of patient willingness to repeat prep/exam and negative public messaging which may deter other patients from undergoing colonoscopy. The guideline recommends colonoscopy should be repeated within 1 yr after the initial IBP- albeit experts agree to do sooner if significant pathology identified. Methods: We used colonoscopies from GIQUIC registry between 2011-2022, to study IBP rates and associated demographics with repeat colonoscopies after IAP and adherence to quality recommendations for repeat colonoscopy <1 (primary analysis). Inclusion criteria were colonoscopies with any indication (screen/surveillance/diagnostic) and MD recommendation repeat <1 yr. Multivariate logistic regression models were used to identify factors, covariates were kept if P ≤ 0.20 evaluating 2 outcomes: repeat colonoscopy after IBP <1 (quality) and ≤5 yrs. Results: From 16,747,770 colonoscopies, IBP was reported in 920,551. Rates of IBPs declined initially from 2011-14 (10.7-5.9%) but plateaued 2015-22 (5.2-5.5%). Primary analysis, limited to 298,148 IAPs, showed adherence to repeat colonoscopy was low across all indications, without demographic differences, even if high risk pathology on index IBP. Tine trend analysis showed significant worsening for compliance with guidelines for repeat colonoscopy across all indications (P < 0.001). Men were less likely to repeat colonoscopy after IBP in <1 year, (odds ratio [OR] 0.93 95% CI 0.91-0.95) and less likely to have follow-up in ≤5 years (OR 0.91 95% CI: 0.90-0.93) compared with women. Rates of IBP on repeat colonoscopy were high (19-24.4%) and significantly worse compared to diagnostics. Repeat IAP 2nd exam Screening Surveillance Diagnostic N repeat totals 48,222 38,761 37,075 N and 2nd IAP (%) 9,177 (19.0) 7,490 (19.3) 9,053 (24.4) P< .0001. Conclusion: Adherence to national quality guideline recommendations for repeat colos following IAP across all categories was low, even if high risk pathology was identified. Rates of IAP on repeat colo were high. Interventions such as navigation strategies to optimize ABP and in particular to address appropriate follow up of IBP, are critically needed to optimize quality of colo.