Publication:

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

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.