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Adherence to recommended colonoscopy surveillance intervals low
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Most patients with adenoma detected in community-based clinical practice did not receive surveillance timed according to guidelines, new research data indicate.
Aiming to assess the rate of adherence to postpolypectomy surveillance guidelines in a community setting, Else-Mariëtte B. van Heijningen, MSc, from the department of public health at Erasmus University Medical Center in the Netherlands, and colleagues used a nationwide registry to identify 2,997 patients with a first adenoma diagnosis (57.2% men; mean age, 58.6 years) from 10 hospitals who underwent colonoscopy between 1998 and 2002. They reviewed their medical records up to December 2008 to assess the findings of index and surveillance colonoscopy and the time interval to first surveillance colonoscopy.
Else-Mariëtte B. van Heijningen
Surveillance was defined as appropriate if performed within the range of ±3 months when a 1-year interval was recommended, and ±6 months when a 2- to 6-year interval was recommended. This analysis was stratified by guideline era; before 2002, 2 to 3 years was recommended for patients with one adenoma and annually otherwise; after 2002, 6 years was recommended for one to two adenomas and 3 years otherwise.
Overall, 21% of patients with adenoma received surveillance that was deemed appropriate, and one-third of the patients received no surveillance at all. There was better adherence to the pre-2002 vs. the 2002 guideline (24% vs. 11%), but in both periods a higher percentage of patients who had three or more adenomas received appropriate surveillance compared with those who had one or two (pre-2002: 30% vs. 24% and 23%; 2002: 18% vs. 9% and 11%, respectively). Before 2002, surveillance was mostly too late or absent (57%), whereas in 2002 it was mostly received too early (48%). Rate of advanced adenoma and CRC was higher in patients with delayed surveillance compared with those who had early or appropriate surveillance, especially pre-2002 (advanced adenoma: 8% vs. 3% and 4%; P<.01; colorectal cancer: 1.8% vs. 0.2% and 0.4%; P<.01, respectively).
“The vast majority of patients with adenoma in community-based clinical practice (76-89%) did not receive surveillance timed according to Dutch postpolypectomy surveillance guidelines,” the researchers concluded. “The poor penetration of the 2002 guideline within 1 year following the implementation, illustrates the importance of convincing evidence to support endorsement of new guidelines by community practice. Our results suggest that there is considerable room for improving the effectiveness and efficiency of surveillance practice, because too early surveillance poses a considerable burden on available resources while delayed surveillance is associated with an increased rate of [advanced adenoma] and especially CRC.”
Disclosure: One of the researchers is a member of an MSD medical advisory board.
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