Repeat Colonoscopy Recommendations Usually Meet Guidelines

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ANN ARBOR, MI – Physician endoscopists’ recommendations for timing of surveillance colonoscopy in average-risk patients with one to two small polyps are consistent with guideline recommendations in about 90% of cases, according to a new study.

The study, which was led by University of Michigan researchers and included the Ann Arbor, MI, VAMC, was published in GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

The study noted that the quality of colorectal cancer (CRC) screening with colonoscopy is primarily dependent on high-quality baseline examinations, but the screening’s cost-effectiveness is more dependent on adherence to guideline recommendations for timing of repeat screening and surveillance colonoscopy. As a result, guideline recommendations should be followed in most, but not all, patients, the authors pointed out.

The guidelines state that average-risk patients with one to two small (<1 cm) adenomas on screening colonoscopy should be told to get surveillance colonoscopy in five to 10 years or to get repeat colonoscopy in 10 years if only one to two small hyperplastic polyps are found. Study authors said they were concerned that the frequency of recommending earlier repeat colonoscopy would come under greater scrutiny with enactment of the Affordable Care Act.

“The aim of our study was to quantify the frequency of appropriate follow-up colonoscopy recommendations after one to two polyps were found during screening colonoscopy in average-risk patients. In addition, we aimed to identify factors associated with adherence to guideline recommendations, including bowel preparation quality, demographic factors and procedural factors,” said lead author Stacy B. Menees, MD. “We found that more than 90 percent of endoscopists’ recommendations for timing of surveillance colonoscopy in average-risk patients with one to two small polyps were consistent with guideline recommendations. Quality of preparation was strongly associated with deviation from guideline recommendations.”

For the study, researchers analyzed databases from the University of Michigan in-hospital medical procedure unit, two University of Michigan outpatient ambulatory surgery centers and the Ann Arbor VAMC in-hospital endoscopy suite during 2009. Average-risk individuals age 50 or over undergoing screening colonoscopy found to have one to two small polyps on screening colonoscopy were included in the study, with the main outcome measurements being frequency of recommending repeat colonoscopy in five years if one to two small adenomas were found and in 10 years if hyperplastic polyps were found.

Of 922 outpatient screening colonoscopies with one to two small polyps found, 90.2% received appropriate recommendations for timing of repeat colonoscopy. At the same time, 84% of patients with one to two small adenomas and 94% of patients with one to two hyperplastic polyps received recommendations that were consistent with guidelines.

Recommendations inconsistent with guidelines were more frequent in patients older than 70 years, those with fair or poor bowel preparation and the presence of two small adenomas vs. one small adenoma, the study found.

“More than 90% of endoscopists’ recommendations for timing of surveillance colonoscopy in average-risk patients with 1 to 2 small polyps are consistent with guideline recommendations,” the authors concluded. “Quality of preparation is strongly associated with deviation from guideline recommendations.”

1 Menees SB, Elliott E, Govani S, Anastassiades C, Schoenfeld P. Adherence to recommended intervals for surveillance colonoscopy in average-risk patients with 1 to 2 small (<1 cm) polyps on screening colonoscopy. Gastrointest Endosc. 2014 Apr; 79(4):551-7. doi: 10.1016/j.gie.2014.01.029. PubMed PMID: 24630082. 

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