Patient adherence to surveillance colonoscopy after endoscopic resection of colorectal polyps and factors associated with loss to follow-up

Abstract

Background and study aims

Post-polypectomy surveillance colonoscopy (SC) plays an integral role in efforts to reduce colorectal cancer risk, but its effectiveness is invariably dependent on patient compliance. This study aimed to evaluate patient adherence to SC after endoscopic resection (ER) of polyps ≥ 20 mm and identify potential barriers associated with loss to follow-up.

Patients and methods

This was a single-center retrospective study evaluating adherence to SC after ER of polyps ≥ 20 mm between April 2018 to December 2021. Adherence to SC was defined as the proportion of patients who underwent follow-up colonoscopy. Multivariate logistic regression was performed to identify factors associated with loss to follow-up.

Results

A total of 959 patients (mean age 67 years; 47.9% women) underwent endoscopic resection of colorectal polyps ≥ 20 mm (mean size 33.2 ± 13.7 mm). Nearly half of the patients (n = 478; 49.8%) were lost to follow-up. On multivariate analysis, factors associated with a higher likelihood of SC non-adherence were: lack of a primary care physician (odds ratio [OR] 1.7;95% confidence interval [CI] 1.3- 2.3; P < 0.05), American Society of Anesthesiologists grade 3 or 4 (OR 1.4; 95% CI 1.1–1.9; P < 0.05), residence > 60 miles from the endoscopy suite (OR 1.6; 95% CI 1.2–2.3; P = 0.02), being referred by a physician outside of our healthcare system (OR 1.4; 95% CI 1.1–1.8; P = 0.01), and lack of written follow-up recommendations on the colonoscopy report (OR 3.6; 95% CI 1.4–10.2; P = 0.01).

Conclusions

Nearly half of patients undergoing ER of colorectal polyps ≥ 20 mm are lost to follow-up. We identified several patient- and healthcare-related factors as barriers to SC adherence. Strategies to address these issues and targeting of high-risk populations are urgently needed to enhance SC programs.

Keywords

Endoscopy Lower GI Tract - Polyps / adenomas / ... - Colorectal cancer - Endoscopic resection (polypectomy, ESD, EMRc, ...)

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