Predictors of No-Shows After an Endoscopic Mucosal Resection in Veterans: A Retrospective Analysis

Introduction Endoscopic mucosal resection (EMR) is a common intervention for large colorectal polyps, but its long-term success depends heavily on post-procedure surveillance to detect recurrence. Despite the critical importance of follow-up appointments, some patients fail to attend these crucial visits. This study aims to identify demographic, clinical, and socioeconomic factors that predict missed follow-up appointments after EMR. By understanding which patients are at the highest risk for non-compliance, we can develop targeted strategies to improve follow-up adherence and optimize long-term outcomes in this population. Methods We conducted a single-center retrospective study at the Saint Louis Veterans Affairs Healthcare System of patients presenting for colon polyp EMR between January 2019 and December 2022. The primary outcome was the no-show rates for the scheduled patient endoscopic follow-up among patients who underwent EMR. A predictive model was then constructed to yield adjusted odds ratios and their prospective 95% confidence intervals. Results A total of 69 patients met the inclusion criteria. Fifty-nine patients followed up within the recommended interval. Ten patients failed to attend their follow-up appointments and were labeled as no-shows. The predictors of no-shows with their adjusted odds ratios and 95% confidence intervals in descending order included previous history of one or more no-shows (3.8, 1.7-8.5, p = 0.002), recommended follow-up interval greater than six months (3.5, 1.1-12.5, p = 0.04), psychiatric comorbidities (2.8, 1.7-4.6, p = 0.002), and history of substance use (2.7, 1.8-6, p = 0.03). Conclusions In patients undergoing EMR, our study identified several risk factors for follow-up non-compliance, including previous no-show history, substance use disorder, and psychiatric comorbidities. These findings suggest that targeted interventions for high-risk patients may improve follow-up adherence. While longer follow-up intervals (>6 months) were associated with increased no-show rates, modifying established surveillance guidelines would require dedicated studies evaluating the safety and efficacy of alternative follow-up schedules.