Impact of non-English primary language on adequacy of bowel preparation for elective colonoscopy: a retrospective audit of a high-volume, culturally diverse endoscopy unit

Mohamed T. Haniff; Ramiz Iqbal; Elvina Wiadji; Jong Woo

doi:10.18203/2349-2902.isj20263280

Authors

Mohamed T. Haniff Department of General Surgery, Concord Hospital, Sydney, NSW, Australia
Ramiz Iqbal Department of General Surgery, Auburn Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
Elvina Wiadji Department of General Surgery, Auburn Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
Jong Woo Department of General Surgery, Auburn Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20263280

Keywords:

Colonoscopy, Bowel preparation, Boston bowel preparation scale, Culturally and linguistically diverse, Non-English speaking background, Health equity, Endoscopy quality indicators

Abstract

Background: Non-English primary language (non-EPL) is a recognized risk factor for inadequate bowel preparation for colonoscopy, which can lead to delayed procedures, repeat colonoscopies, and increased healthcare costs. New South Wales has the highest proportion of non-EPL residents of any Australian state, and endoscopy units serving these communities must implement effective multilingual strategies to maintain care standards. Auburn Hospital has adopted a proactive approach using professional interpreter services, translated preparation resources, and language-specific patient education clinics. This study aimed to assess the effectiveness of these interventions by comparing bowel preparation quality and the rate of inadequate colonoscopy preparation between non-EPL and English primary language (EPL) patients.

Methods: A retrospective review of elective colonoscopies performed from January to June 2025 was conducted at a high-volume, culturally diverse metropolitan Sydney hospital. The primary outcome was the rate of inadequate bowel preparation, defined as a Boston bowel preparation score (BBPS) below 6. Secondary outcomes included median BBPS and rates of deferred or repeated colonoscopies. Outcomes were compared between EPL and non-EPL cohorts using Fisher’s exact test for categorical variables and the Mann–Whitney U test for BBPS score distributions.

Results: A total of 720 elective colonoscopies were analysed (non-EPL: n=324, 45%; EPL: n=396, 55%). Twenty-nine patients (4%) had inadequate preparation (BBPS <6); of these, 55% were EPL (n=16) and 45% were non-EPL (n=13), corresponding to inadequate preparation rates of 4.0% in both groups. There was no statistically significant difference in preparation quality, with both groups achieving a median BBPS of 8 (IQR 7–9; non-EPL mean 7.83 [SD 1.16]; EPL mean 7.96 [SD 1.04]).

Conclusions: Contrary to prior studies, non-EPL status was not associated with poorer bowel preparation at this institution. The overall inadequate preparation rate of 4% meets the GESA benchmark of less than 10% and is consistent with high-performing endoscopy centres, likely reflecting the effectiveness of the multilingual communication strategies in place.

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