Adherence to surveillance guidelines after removal of colorectal adenomas: A large, community-based study

Else-Mariette B. van Heijningen*, Iris Lansdorp-Vogelaar, Ewout W. Steyerberg, S. Lucas Goede, Evelien Dekker, Wilco Lesterhuis, Frank ter Borg, Juda Vecht, Pieter Spoelstra, Leopold Engels, Clemens J. M. Bolwerk, Robin Timmer, Jan H. Kleibeuker, Jan J. Koornstra, Harry J. de Koning, Ernst J. Kuipers, Marjolein van Ballegooijen

*Corresponding author for this work

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Abstract

Objective To determine adherence to recommended surveillance intervals in clinical practice.

Design 2997 successive patients with a first adenoma diagnosis (57% male, mean age 59 years) from 10 hospitals, who underwent colonoscopy between 1998 and 2002, were identified via Pathologisch Anatomisch Landelijk Geautomatiseerd Archief: Dutch Pathology Registry. Their medical records were reviewed until 1 December 2008. Time to and findings at first surveillance colonoscopy were assessed. A surveillance colonoscopy occurring within +/- 3 months of a 1-year recommended interval and +/- 6 months of a recommended interval of 2 years or longer was considered appropriate. The analysis was stratified by period per change in guideline (before 2002: 2-3 years for patients with 1 adenoma, annually otherwise; in 2002: 6 years for 1-2 adenomas, 3 years otherwise). We also assessed differences in adenoma and colorectal cancer recurrence rates by surveillance timing.

Results Surveillance was inappropriate in 76% and 89% of patients diagnosed before 2002 and in 2002, respectively. Patients eligible under the pre-2002 guideline mainly received surveillance too late or were absent (57% of cases). For patients eligible under the 2002 guideline surveillance occurred mainly too early (48%). The rate of advanced neoplasia at surveillance was higher in patients with delayed surveillance compared with those with too early or appropriate timed surveillance (8% vs 4-5%, p

Conclusions There is much room for improving surveillance practice. Less than 25% of patients with adenoma receive appropriate surveillance. Such practice seriously hampers the effectiveness and efficiency of surveillance, as too early surveillance poses a considerable burden on available resources while delayed surveillance is associated with an increased rate of advanced adenoma and especially colorectal cancer.

Original languageEnglish
Pages (from-to)1584-1592
Number of pages9
JournalGut
Volume64
Issue number10
DOIs
Publication statusPublished - Oct-2015

Keywords

  • POST-POLYPECTOMY SURVEILLANCE
  • POLYP SURVEILLANCE
  • FOLLOW-UP
  • CLINICAL-PRACTICE
  • NATIONWIDE SURVEY
  • UNITED-STATES
  • COLONOSCOPY
  • CANCER
  • RISK
  • APPROPRIATENESS

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