Impact of Primary Language on Early Repeat Screening Colonoscopy

Background: Repeat colonoscopy ≤1 year after a screening colonoscopy is recommended when bowel preparation is inadequate due to the potential of missed advanced neoplasia. Whether patients whose primary language is not English (NEPL) have a greater risk of repeat colonoscopy ≤1 year after screening colonoscopy than native English speakers (EPL) is unknown. We investigated the primary language in early repeat colonoscopy. Methods: The TriNetX Research Network database was used to compare rates of repeat colonoscopy ≤1 year between patients with NEPL and EPL. Propensity score matching (PSM) was used to adjust for factors associated with inadequate bowel preparation. Risk of repeat colonoscopy ≤1 year of baseline screening exam, colorectal polyps, and colorectal cancer (CRC) on repeat colonoscopy were expressed as odds ratios (OR) with 95% CI. Results: Among 611,149 patients undergoing screening colonoscopy (mean age 58.3 y, 63.6% white, 7.1% Hispanic), 31,118 had NEPL and 580,031 had EPL. After PSM, each cohort included 29,446 patients. NEPL patients had higher odds of undergoing repeat colonoscopy within 1 year compared with EPL patients (1.9% vs. 1.3%; OR: 1.49, 95% CI: 1.30-1.69). In the matched cohorts, the rate of polyp detection on repeat colonoscopy was similar, but NEPL patients had higher odds of CRC detection (0.8% vs. 0.6%; OR: 1.4, 95% CI: 1.1-1.7). Conclusions: NEPL patients had greater odds of early repeat colonoscopy than EPL patients. Although colorectal polyps and CRC were infrequent in both groups, NEPL patients appeared to be at higher risk of CRC detection. Language-tailored interventions may improve bowel preparation quality and reduce repeat procedures.