National CRC Screening Summit

Schmitt
Pdf Summary
Open Access Endoscopy (OAE) refers to performing endoscopic procedures like colonoscopy upon direct referral by physicians without prior clinic consultations, aiming to reduce patient wait times and extra office visit costs. First introduced in the US in 1983, OAE has become widespread, with 40% of colonoscopies being open access by 2015. The American Society for Gastrointestinal Endoscopy (ASGE) set guidelines in 2002 and updated in 2015 emphasizing appropriate use, patient education, pre-procedure assessment, informed consent (which may be obtained same-day), and communication of results. Scheduling must consider insurance coverage, patient’s ASA physical status (which classifies anesthesia risk), procedure complexity, and appropriate site of service (office, ambulatory center, or hospital).<br /><br />Concerns with OAE include the risk of inappropriate procedures, medicolegal issues (related to informed consent and managing comorbidities), variable bowel preparation quality, high no-show or last-minute cancellations, and risk of the endoscopist becoming more of a technician than a clinician. Studies show about 29-39% of OAE colonoscopies may be inappropriately indicated, often ordered by generalists. Comorbidity assessment through checklists and triage reduces adverse events and helps determine sedation needs.<br /><br />Quality of bowel preparation in OAE is generally comparable to office visits, with adequate preparation rates around 75-86% and adenoma detection rates (ADR) varying by study but showing no significant difference. No-show rates range from 2-33%, influenced by demographic and insurance factors.<br /><br />Navigation programs within OAE improve outcomes, including bowel prep quality, completion rates, and ADR. OAE markedly reduces wait times—from several months down to weeks—improving timely screening and diagnosis.<br /><br />To ensure safety, efficiency, and quality in OAE programs, clear policies aligning with ASGE guidelines, proper patient assessment, communication about medications and transportation, bowel preparation protocols, and robust follow-up of no-shows with feedback to referring providers are essential.
Keywords
Open Access Endoscopy
Colonoscopy
ASGE Guidelines
Patient Education
Informed Consent
Bowel Preparation Quality
No-show Rates
Comorbidity Assessment
Procedure Scheduling
Navigation Programs