P3831 - Quality of Bowel Prep in Patients Undergoing Direct Access Colonoscopy Using OTC Bowel Preps - A Private Practice Experience

Alexander Perez, ¹, Anika Koka, ², Julian Ignacio Perez, BS³, Julian Perez-Barrios, MD⁴, Ramesh Koka, MD^4
1University of Central Florida, Fort Myers, FL; ²Canterbury School, Fort Myers, FL; ³Stanford University, Stanford, CA; ⁴Gastroenterology Associates, Fort Myers, FL

Introduction: Direct access colonoscopy (DAC) improves screening rates by removing the pre procedure office visit. However,this may increase the risk of incomplete preparation due to lack of inperson instruction and using OTC colon preps.The aim of this study was to establish non inferiority of DAC in comparison to standard non DAC screening using both OTC and prescription colon preps.

Methods: A retrospective review was conducted of 1000 adult patients who underwent a DAC and non DAC at an outpatient center between March 2023 to March of 2024. The standard bowel preparation was OTC split dose Miralax /Gatorade with duclolax. A small proportion of patients also requested magnesium citrate prep(29).Patients were instructed to start their second dose exactly 7 hours prior to their scheduled procedure time and finish within an hour.As a comparison group, 500 patients who were prepped in office for screening colonoscopy using different preps were reviewed.Patients were grouped into AM or PM groups. Quality of prep was rated as follows: 1=excellent/good,2=adequate,3=fair,4=poor.Secondary objectives included comparing prep score across age,race,gender,diabetes and BMI.Statistical analysis was performed using R programming language and Bayesian information criteria to find a reduced model which best fit the data. Welch Two sample T test was performed to test the null hypothesis that the quality of prep is equal between the groups.

Results: We identified 486 DAC and 446 non DAC patients, excluding patients with insufficient data .In the DAC group, 84.15% had a prep score of 1&2, 14.81% a score of 3&4.In comparison non DAC group, 83.85% had a prep score of 1&2, 16.14% had a bowel prep score of 3/4. There was no statistical difference between both groups with a calculated p-value of 0.12.There was no difference shown between AM and PM colonoscopies in both groups, with p value of 0.28 in DAC vs 0.45 in non DAC groups.There was no difference in quality of prep when compared with variables including age, race, sex, BMI, diabetes and type of prep.

Discussion: This study aligns with the notion that DAC indeed can improve screening rates in the community, OTC preps such as miralax/gatorade are sufficient to ensure an adequate prep when compared to standard prescription preps. The variables including age,race, diabetes,and BMI did not affect the quality of prep in the DAC group supporting the premise to expand the inclusion criteria for DAC to cast a wider net to improve overall colon screening rates.



Disclosures:


Alexander Perez, ¹, Anika Koka, ², Julian Ignacio Perez, BS³, Julian Perez-Barrios, MD⁴, Ramesh Koka, MD⁴. P3831 - Quality of Bowel Prep in Patients Undergoing Direct Access Colonoscopy Using OTC Bowel Preps - A Private Practice Experience, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.