Nearly 1 in 3 outpatient endoscopies at Cleveland Clinic’s academic center are canceled at the last minute or end as no-shows. Data from academic endoscopy units shows how to bring that number down.
In a retrospective study of more than 45,000 outpatient endoscopic procedures scheduled from January 2024 through October 2025, Cleveland Clinic found 30.2% of procedures at its academic center were canceled at the last minute or missed, compared with 18% at a community site.
At the academic center, Medicaid patients had 82% higher odds of a late cancellation or no-show than patients with other insurance. Colonoscopies had 42% higher odds than upper endoscopies. Each 10-point increase on the Area Deprivation Index raised the odds 33%. Those effects were weaker at the community site: 44%, 21% and 7%, respectively.
“As deprivation increases, so does the likelihood of a late cancellation or no-show,” said Brian Baggott, MD, a Cleveland Clinic gastroenterologist and study researcher.
Studies from three academic programs show how to cut no-shows and failed preps. The studies are older and some are small, but the results are consistent.
1. University of Chicago Medicine: Text navigation nearly halved no-shows
UChicago randomized 1,625 colonoscopy patients in 2019. About half got usual care, which was paper instructions and a nursing pre-call. The rest got timed text messages with diet and bowel prep instructions.
The no-show rate was 8% in the texting group vs. 14% in usual care, according to the study in the Journal of Clinical Gastroenterology. No-shows plus same-day cancellations were 10% vs. 16%. Adequate prep in screening and surveillance colonoscopies was 93% vs. 88%.
2. Penn Medicine: 90% of texting patients completed colonoscopy
Penn Medicine piloted an automated texting program with two-way messaging in April 2018. Of patients who used it, 90% completed their colonoscopy, compared with 62% of patients who got paper instructions and a phone reminder, according to the study in Health Education & Behavior. The pilot was small: 22 patients in the texting group and 50 controls.
About three-quarters of texting patients replied with questions, which staff answered within 24 hours.
“We think text messaging is successful because it is patient-centered,” said lead author Nadim Mahmud, MD.
3. Brigham and Women’s Hospital: Prep failures fell by two-thirds
In a three-month pilot in 2017 of an automated texting tool, Brigham’s endoscopy center cut inadequate bowel prep from 11.5% to 3.8% and no-shows from 6.1% to 4.3%, according to the hospital.
“I anticipated that we’d see an improvement, but the preliminary results were beyond what I expected,” said Jennifer Nayor, MD, of Brigham’s Division of Gastroenterology, Hepatology and Endoscopy.
What it costs and what it returns
Lower-tech fixes also pay off. Stanford’s endoscopy unit had a nurse call patients seven days before their procedure, replacing mailed reminders. The calls were tied to 33% lower odds of a no-show and recovered $48,765 in reimbursement. That left $16,190 in net savings after startup and maintenance costs and a projected $43,173 a year in net revenue, according to a 2016 study in Gastrointestinal Endoscopy.
Cleveland Clinic researchers said the findings can help identify which patients need more support, or a different screening option, before the procedure date.
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