Should the quality of preparation impact postcolonoscopy follow-up recommendations?

A high-quality bowel cleansing preparation is an essential prerequisite for a safe, efficient, and accurate colonoscopy. Large studies, however, have shown that up to 25% of patients undergoing colonoscopy have what is considered to be an inadequate preparation. A well-done survey reported in this issue of the American Journal of Gastroenterology by Ben-Horin et al. found considerable variability among endoscopists in their assessment of preparation adequacy from photographs of three representative cases. When the preparation was judged suboptimal, follow-up colonoscopy often was recommended at shorter time intervals than is currently indicated by clinical guidelines. Because this practice is not supported by any direct investigation, a better practice might be to determine if the preparation is poor or inadequate, indicating instead the need for a prompt repeat preparation and another colonoscopy.