{
  "abstract": "Introduction Repeat colonoscopy after an index procedure may reflect incomplete examination due to patient- or operator-related factors and has implications for patients and endoscopy service utilisation. To address backlogs, many UK centres employ insourced endoscopists alongside substantive staff, although repeat procedure rates between these groups are not known. Here, we examined whether rates of repeat lower gastrointestinal (LGI) endoscopy differed between substantive and insourced endoscopists.Methods We retrospectively reviewed LGI endoscopies performed between October 2022-June 2025. Repeat LGI procedures occurring within 60 days of index colonoscopy were identified. Endoscopists were categorised as substantive or insourced, and analysis was restricted to those performing >200 colonoscopies. Funnel plots were used to visualise repeat procedure rates and to categorise endoscopists by outlier status: those > 97% confidence limit were classified as high repeat-rate endoscopists, and those < 95% confidence limit as low repeat-rate endoscopists.Case-note review was undertaken for procedures performed by high repeat-rate endoscopists and by a random sample from low repeat-rate groups, with a maximum of 70 reviews per endoscopist. The primary outcome was the rate of repeat LGI procedures between substantive and insourced endoscopists. Secondary outcomes were the indications for repeat procedures.Results A total of 53,873 LGI procedures were performed by 183 endoscopists, including 43,360 colonoscopies. Of these, 52.2% (22,641/43,360) were performed by substantive and 47.8% (20,719/43,360) by insourced endoscopists. Overall, 7.3% (3,175/43,360) of colonoscopies were repeated within 60 days. For the primary outcome, substantive endoscopists had a lower repeat rate than insourced endoscopists (6.9% vs 7.8%, χ 2 p<0.01). Funnel plot analysis demonstrated greater variation among insourced endoscopists.For secondary outcomes, 752 case notes were reviewed. Poor bowel preparation, a metric not included as a performance indicator within current national guidelines, was the most frequently documented indication for repeat colonoscopy. Repeat procedures attributed to poor preparation were 4x lower among low versus high repeat-rate endoscopists (1.4% vs 6.7%).Conclusions Repeat LGI procedures within 60 days of colonoscopy were more frequent among insourced versus substantive endoscopists. While some repeat procedures are clinically appropriate, the observed variation suggests scope to reduce potentially avoidable repeats. Differences between endoscopist groups may reflect system-level or working environment factors rather than individual expertise. Further multicentre evaluation is required to assess generalisability.Abstract P345 Figure 1Funnel plot showing repeat rates comparing substantive versus insource endoscopist. Purple line denotes the mean and the blue and orange dotted line indicates the 95% and 97% confidence limit, respectively",
  "authors": [
    {
      "affiliations": [
        "Department of Gastroenterology, Basildon and Thurrock University Hospital, Basildon, UK, Cambridge, United Kingdom",
        "Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom"
      ],
      "name": "Lewis David"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Basildon and Thurrock University Hospital, Basildon, UK, Cambridge, United Kingdom",
        "Early Cancer Institute, University of Cambridge, Cambridge, United Kingdom"
      ],
      "name": "W Keith Tan"
    },
    {
      "affiliations": [
        "Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom"
      ],
      "name": "Abdul Rahimi"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Basildon and Thurrock University Hospital, Basildon, UK, Cambridge, United Kingdom"
      ],
      "name": "Linda Norton"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Basildon and Thurrock University Hospital, Basildon, UK, Cambridge, United Kingdom"
      ],
      "name": "John Paul Imperio"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Basildon and Thurrock University Hospital, Basildon, UK, Cambridge, United Kingdom"
      ],
      "name": "Senna Devassy"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Basildon and Thurrock University Hospital, Basildon, UK, Cambridge, United Kingdom"
      ],
      "name": "Javaid Subhani"
    }
  ],
  "title": "P345 Rate of repeat colonoscopies within 60 days of index colonoscopy: a multicentre comparative analysis of substantive versus in-sourced endoscopists",
  "uid": "77f21ab7-a895-52e2-9a77-e5b3d44d38c4"
}