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In the article by Bowles et al (Gut 2004;53:277–83), poor bowel preparation is cited as the cause of 19.6% of failures to achieve complete colonoscopy. Similarly high values of up to 35% have been quoted elsewhere.
In a personal series of 1195 procedures, only 19 of 197 (9.6%) failures were attributed to this cause. This difference was highly significant (p<0.001).
As choice of laxative agent and population demographics are similar, one could conclude that either Guernsey patients are more compliant with or responsive to bowel preparation or that minimal faecal residue present in a difficult colon is used as a non-operator dependent reason (excuse?) for what is basically a technique failure.
I suspect the same applies to “patient discomfort” which, at 34.7%, is also significantly higher (p<0.001) than my own values of 31/197 (15.7%). My typical sedation is 5 mg midazolam and 10 mg nalbuphine.
I confess that my usage of these excuses has declined over the years as my success rate has climbed! It is time to get training and be honest.