Non-English Primary Language Linked to Greater Repeat Screening Colonoscopy Risk

New research is shedding light on the impact of language barriers on bowel preparation for colonoscopy and the subsequent need for repeat colonoscopies.

Findings from the retrospective cohort study of TriNetX Research Network data were presented at Digestive Disease Week (DDW) 2025 by Anthony Kerbage, MD, an internal medicine resident at the Cleveland Clinic, and highlight potential challenges in bowel preparation quality for patients with a primary language other than English.

“There's a lot to understand, and the instructions need to be clearly understood in order for the patient to take the bowel prep as instructed and then to optimize the bowel preparation for that colonoscopy,” Kerbage explained to HCPLive. “Unfortunately, if patients have limited English proficiency or just general limited health literacy, they might not fully understand how to take their bowel preparation, and this might lead to inadequate bowel preparation.”

He goes on to explain how the US Preventive Services Task Force recommends a repeat screening colonoscopy within 1 year if the initial screening colonoscopy had inadequate bowel preparation due to the risk of missed lesions.

Kerbage and colleagues compared repeat screening colonoscopy rates within 1 year between patients with English as their primary language and those with a primary language other than English. Propensity score matching (1:1) was performed to adjust for age, gender, BMI, diabetes, opioid use, GLP-1 receptor agonist use, prior colorectal surgery, and neurological disorders.

A total of 308,186 patients who underwent screening colonoscopies were included in the study, with a mean age of 65 (± 10) years. The majority of patients were female (54.15%) and White (65.88%), with 10.36% identifying as Hispanic or Latino.

The primary language other than English cohort consisted of 18,022 patients, while the English primary language cohort included 290,164 patients. After propensity score matching, each cohort included 17,981 patients.

Upon analysis, the rate of repeat screening colonoscopy within 1 year was significantly greater in the primary language other than English cohort (1.1%) compared with the English primary language cohort (0.8%) (adjusted odds ratio, 1.42; 95% CI, 1.14–1.75; P <.001).

“Non-English speaking patients had higher rates of repeat colonoscopy within 1 year, but I have to mention that the rates were low in both cohorts,” Kerbage said, noting that although the rates were low, the difference between the cohorts did reach statistical significance.

He was careful to explain the limitations of this research, referring to it as a “foundation study” for future studies to build upon.

Editors’ note: Kerbage has no relevant disclosures.

Reference

1. Kerbage A, Haddad S, Deiri DA, et al. IMPACT OF NON-ENGLISH PRIMARY LANGUAGE ON REPEAT SCREENING COLONOSCOPY RATES. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.