Interpretation and adherence to the updated risk-stratified guideline for colonoscopy surveillance after polypectomy – a nationwide survey

Abstract

Background and study aims Low adherence to the Dutch guideline for colonoscopy surveillance after polypectomy led to release of a new guideline in 2013. This new guideline was risk-stratified at a more detailed level than the previous one to achieve more efficient use of colonoscopy resources. This study assessed the feasibility of the risk-stratified guideline by evaluating correct interpretation of and adherence to this guideline.

Methods Based on semi-structured interviews with 10 gastroenterologists, we developed an online survey to evaluate gastroenterologists’ recommendations for surveillance in 15 example cases of patients with polyps. If recommended intervals differed from the new guideline, respondents were asked to indicate their motives for doing so.

Results Ninety-one of 592 (15.4 %) invited gastroenterologists responded to at least one case, of whom 84 (14.2 %) completed the survey. Gastroenterologists gave a correct recommendation in a median of 10 of 15 cases and adherence per case ranged from 14 % to 95 % (median case 76 %). The two cases that addressed management of serrated polyps were least often answered correctly (14 % and 28 % correct answers). Discrepancies were mainly due to misinterpretation of the guideline with respect to serrated polyps (48 %) or misreading of the questions (30 %).

Conclusions Median adherence to the updated colonoscopy surveillance guideline of 76 % seems reasonable, and is higher than adherence to the previous guideline (range: 22 %-80 %, median 59 %). This shows that detailed (more complex) risk stratification for designation of a surveillance interval is feasible. Adherence could potentially be improved by clarifying correct interpretation of serrated polyps.

Publication History

Received: 14 July 2019

Accepted: 24 April 2020

Article published online:
22 September 2020

• References

• 1 Jemal A, Bray F, Center MM. et al. Global cancer statistics. CA Cancer J Clin 2011; 61: 69-90
• 2 Cottet V, Jooste V, Fournel I. et al. Long-term risk of colorectal cancer after adenoma removal: a population-based cohort study. Gut 2012; 61: 1180-1186
• 3 Leung K, Pinsky P, Laiyemo AO. et al. Ongoing colorectal cancer risk despite surveillance colonoscopy: the Polyp Prevention Trial Continued Follow-up Study. Gastrointest Endosc 2010; 71: 111-117
• 4 Martinez ME, Baron JA, Lieberman DA. et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology 2009; 136: 832-841
• 5 Atkin WS, Valori R, Kuipers EJ. et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition--Colonoscopic surveillance following adenoma removal. Endoscopy 2012; 44 (Suppl. 03) 151-163
• 6 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
• 7 Leddin D, Armstrong D, Borgaonkar M. et al. The 2012 SAGE wait times program: Survey of Access to GastroEnterology in Canada. Can J Gastroenterol 2013; 27: 83-89
• 8 Patel VB, Nahar R, Murray B. et al. Exploring implications of Medicaid participation and wait times for colorectal screening on early detection efforts in Connecticut -- a secret-shopper survey. Connecticut Med 2013; 77: 197-203
• 9 Schreuders EH, Ruco A, Rabeneck L. et al. Colorectal cancer screening: a global overview of existing programmes. Gut 2015; 64: 1637-1649
• 10 Terhaar Sive Droste JS, Craanen ME, van der Hulst RW. et al. Colonoscopic yield of colorectal neoplasia in daily clinical practice. World J Gastoenteroly 2009; 15: 1085-1092
• 11 Huppertz J, Coriat R, Leblanc S. et al. Application of ANAES guidelines for colonoscopy in France: a practical survey. Gastroenterol Clin Biolog 2010; 34: 541-548
• 12 Mulder SA, Ouwendijk RJ, van Leerdam ME. et al. A nationwide survey evaluating adherence to guidelines for follow-up after polypectomy or treatment for colorectal cancer. J Clin Gastroenterol 2008; 42: 487-492
• 13 van Kooten H, de Jonge V, Schreuders E. et al. Awareness of postpolypectomy surveillance guidelines: a nationwide survey of colonoscopists in Canada. Can J Gastroenterol 2012; 26: 79-84
• 14 NVMDL. CBO guideline. 2014 http://www.mdl.nl/uploads/240/1308/Richtlijn_Coloscopie_Surveillance_definitief_2013.pdf
• 15 Bonnington SN, Rutter MD. Surveillance of colonic polyps: Are we getting it right?. World J Gastroenterol 2016; 22: 1925-1934
• 16 van Heijningen EM, Lansdorp-Vogelaar I, Kuipers EJ. et al. Features of adenoma and colonoscopy associated with recurrent colorectal neoplasia based on a large community-based study. Gastroenterology 2013; 144: 1410-1418
• 17 de Jonge V, Sint Nicolaas J, van Leerdam ME. et al. Systematic literature review and pooled analyses of risk factors for finding adenomas at surveillance colonoscopy. Endoscopy 2011; 43: 560-572
• 18 Boolchand V, Olds G, Singh J. et al. Colorectal screening after polypectomy: a national survey study of primary care physicians. Ann Internal Med 2006; 145: 654-659
• 19 Iskandar H, Yan Y, Elwing J. et al. Predictors of poor adherence of US gastroenterologists with colonoscopy screening and surveillance guidelines. Digest Dis Sci 2015; 60: 971-978
• 20 Saini SD, Nayak RS, Kuhn L. et al. Why don't gastroenterologists follow colon polyp surveillance guidelines? results of a national survey. Journal of clinical gastroenterology 2009; 43: 554-558
• 21 Hassan C, Quintero E, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842-851
• 22 Matsuda T, Chiu HM, Sano Y. et al. Surveillance colonoscopy after endoscopic treatment for colorectal neoplasia: From the standpoint of the Asia-Pacific region. Digest Endosc 2016; 28: 342-347