Factors associated with incomplete colonoscopy: a population-based study

Gastroenterology. 2007 Jun;132(7):2297-303. doi: 10.1053/j.gastro.2007.03.032. Epub 2007 Mar 21.


Background & aims: The U.S. Multi-Society Task Force on Colorectal Cancer sets a target of cecal intubation in at least 90% of colonoscopies. We conducted a population-based study to determine the colonoscopy completion rate and to identify factors associated with incomplete procedures.

Methods: Men and women 50 to 74 years of age who underwent a colonoscopy in Ontario between January 1, 1999, and December 31, 2003, were identified. The first (index) colonoscopy was classified as complete or incomplete. A generalized estimating equations model was used to evaluate the association between patient, endoscopist (specialty, colonoscopy volume), and setting (academic hospital, community hospital, private office) factors and incomplete colonoscopy.

Results: A total of 331,608 individuals had an index colonoscopy, of which 43,483 (13.1%) were incomplete. Patients with an incomplete colonoscopy were older (odds ratio [OR] 1.20 per 10-year increment; 95% confidence interval [CI]=1.18-1.22), more likely to be female (OR 1.35; 95% CI: 1.30-1.39), have a history of prior abdominal surgery (OR 1.07; 95% CI: 1.05-1.09) or prior pelvic surgery (OR 1.04; 95% CI: 1.01-1.06). For colonoscopies done in a private office, the odds of an incomplete procedure were more than 3-fold greater than for procedures done in an academic hospital (OR 3.57; 95% CI: 2.55-4.98).

Conclusions: In usual clinical practice in Ontario, 13.1% of colonoscopies are incomplete. The factors most strongly associated with incomplete colonoscopy were increased patient age, female sex, and having the procedure in a private office. Quality improvement programs are needed to improve colonoscopy completion rates.

MeSH terms

  • Abdomen / surgery
  • Academic Medical Centers
  • Age Factors
  • Aged
  • Cecum*
  • Clinical Competence
  • Cohort Studies
  • Colonoscopy / standards*
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / prevention & control
  • Female
  • Humans
  • Intubation, Gastrointestinal*
  • Male
  • Medical Records
  • Middle Aged
  • Multivariate Analysis
  • Pelvis / surgery
  • Private Practice
  • Quality Indicators, Health Care*
  • Sex Factors