Introduction: Direct Access Colonoscopy (DAC) does not require pre-colonoscopy consultation and may improve access for patients needing screening and surveillance. DAC eligibility criteria vary widely, and we developed a novel, DAC program using EMR patient data to assess appropriateness for inclusion. This study aimed to evaluate the efficacy and quality of our DAC program and compare to traditional, Office-Scheduled Colonoscopy (OSC).
Methods: We conducted a retrospective, single-center study of OSC and DAC patients ages 45-75 with a screening or surveillance indication over 13 months. Primary outcome was Complete Colonoscopy (CC): to cecum/ileum/anastomosis, adequate prep, < 90 days from gastroenterology contact. Patients not meeting CC criteria were classified as Incomplete Colonoscopy (IC). Secondary endpoints: time to CC, adenoma detection rate (ADR).
Results: 2,651 patients met inclusion criteria: mean age 58, 57% female, 65% non-White, 86% neither Hispanic/Latino. 1,143 DAC patients (62%) vs. 473 OSC patients (57%) achieved CC: average interval 36 days (DAC) vs. 42 days (OSC), mean prep score 7.94/10 (DAC) vs. 7.45/10 (OSC), and ADR 38% (DAC) vs. 43% (OSC). Top reasons for IC: patient cancellation (35%), no show (28%), inadequate prep (9%). Non-Whites were less likely than Whites (59% vs. 69%; p < 0.001) to achieve CC.
Discussion: DAC is non-inferior to OSC for primary endpoint of CC (p < 0.001) with no significant differences across age, gender, and indication. Failure to attend colonoscopy accounted for most ICs, and non-Whites were less likely to have a CC. Further work is needed to maximize CC rate across all demographics.
Israilevich, Rachel; White, Mary; Lam, Sophia; Chipkin, Benjamin; and Kastenberg, MD, David, "A Single Academic Center's Experience with Direct Access Colonoscopy" (2021). Phase 1. Paper 24.