early 30% of patients who receive colonoscopies had a precolonoscopy office visit, according to a study in JAMA.1 Such office visits may be unnecessary; open-access colonoscopy for colon cancer screening and polyp surveillance has been available in the United States since the 1990s.

The generally low risk of colonoscopy and the widely accepted guidelines for polyp surveillance and colon cancer screening may render precolonoscopy gastroenterology office visits unnecessary.

This study analyzed health care data from across the United States from the MarketScan Commercial Claims and Encounters database (Truven Health Analytics). Data from patients aged 50 to 64 years with no previous diagnosis of colon cancer or inflammatory bowel disease with a colonoscopy between 2010 and 2013 were used.

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The study revealed that 247 542 out of 842 849 (29%) of patients attended a gastroenterology visit within the 6 weeks prior to colonoscopy. Average pay per gastroenterology office visit was $123.83. Distributed across all patients, these office visits add $36.37 to each colonoscopy.

Patients attending precolonoscopy appointments had higher Charlson Comorbidity Index (CCI) scores, with 66.4% having a CCI of 0. Patients with office visits were also more likely to reside in the South.

The higher CCI of patients with office visits suggests a higher risk of adverse events. Therefore, these results may be the upper limit of unnecessary appointments. The study was led by Kevin R. Riggs, MD, MPH, of the Johns Hopkins University School of Medicine in Baltimore, MD.

“Although the precolonoscopy office visits added a modest $36 per colonoscopy in this population, there are an estimated 7 million screening colonoscopies performed in the United States annually, so the cumulative costs are significant. Identifying which patients benefit from a precolonoscopy office visit and targeting those patients could increase the value of colon cancer screening,” the authors stated.

The authors noted that the study is limited as the exact circumstances of office visits could not be determined.


1. Riggs KR, Segal JB, Shin EJ, Pollack CE. Prevalence and Cost of Office Visits Prior to Colonoscopy for Colon Cancer Screening. JAMA. 2016;315(5):514-515.